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Tear function and ocular surface changes after corneal cross-linking

Poster Details

First Author: E.Kalkan Akcay TURKEY

Co Author(s):    S. Uysal   A. Kilicarslan   P. Kosekahya   G. Hondur   F. Ozturk   N. Cagil

Abstract Details


To report tear function and ocular surface changes 3 months after corneal cross-linking (CXL) using riboflavin and ultraviolet-A light in the treatment of keratoconus.


Center of Keratoconus and Refractive Surgery, Yildirim Beyazit University, Ankara Ataturk Training and Research Hospital, Ankara, Turkey.


Fifty five eyes of 44 patients were distributed into 2 groups: patients in group 1 (33 eyes) underwent CXL, whereas patients in group 2 (22 eyes) underwent CXL combined with phototherapeutic keratectomy (PTK). Ocular surface disease index scores (OSDI), tear osmolarity, Schirmer test, tear film break-up time (TBUT), fluorescein (Fl) and rose bengal (RB) staining, and conjunctival impression cytology (IC) were obtained from all eyes before treatment and 3 months after treatment. After topical anesthesia, IC specimens were collected from temporal and superior bulbar conjunctiva. Conjunctival samples were evaluated according to Nelson’s grading scheme.


In group 1, the mean OSDI, tear osmolarity, Schirmer test, TBUT, Fl and RB staining did not show significant change 3 months after CXL (p>0.05 for all variables). Temporal and superior bulbar conjunctival IC showed goblet cell loss and conjunctival squamous metaplasia 3 months after CXL(p=0,004, p=0,005; respectively). In group 2 RB staining scores were significantly higher compared with baseline (p=0,029). Also TBUT showed significant decrease 3 months after CXL (p=0,026). Superior IC had significantly higher grades of squamous metaplasia and goblet cell loss compared with baseline (p=0,007) but no difference on the temporal conjunctiva.


The reduction in goblet cell density and squamous metaplasia on the superior and temporal bulbar conjunctiva found after CXL treatment was probably attributable to several factors such as toxicity of the topical medication and inflammation or mechanical damage by the lid speculum. Whereas the metaplasia did not lead to a dry eye syndrome in eyes after CXL. However; dry eye syndrome has been observed in patients underwent CXL combined with PTK.

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