Official ESCRS | European Society of Cataract & Refractive Surgeons


Impact of CXL on corneal biomechanics and patient behaviour

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Session Details

Session Title: Corneal Cross-Linking

Session Date/Time: Monday 16/09/2019 | 16:00-18:00

Paper Time: 17:42

Venue: South 5

First Author: : P.Legout FRANCE

Co Author(s): :    V. Saunier   D. Touboul                          

Abstract Details


Many studies find a causal link between eye rubbing and Keratoconus (KC). In addition, numerous studies have shown the effectiveness of corneal cross-linking (CXL) in the treatment of this pathology. It seemed interesting to us to evaluate the impact of CXL on eye rubbing. We also studied its effect on corneal biomechanics.


CHU Bordeaux, France 1 place Amélie Raba-Léon, 33000 Bordeaux


We have included consecutively and prospectively a series of 50 eyes of 44 patients who benefit from an accelerated CXL Epi- OFF (A-CXL) for progressive KC. Patients completed a questionnaire detailing the specific modalities of eye friction and the possible impact of CXL on reducing eye rubbing. A complete clinical examination, including comparative central corneal sensitivity, corneal topography (OCT CASIA 2), corneal biomechanical evaluation by CORVIS ST were performed preoperatively, then at 1, 3 and 9 months postoperatively.


79% of patients were male, the average age was 24.7 years. The rate of patients reporting frequent eye rubbing was 81.5% preoperatively. There is a decrease in this percentage at 1 month postoperatively (p<0.001). At 3 months postoperatively, 93.7% of patients thought that CXL had reduced their friction: 44.4% immediately, 33.3% after one week and 22.2% after one month. Corneal sensitivity decreased at 1 month postoperatively in patients with CXL compared to the non-operated eye (p=0.012). Pachymetry was decreased at 1month post-operatively (p= 0.011). None of the data reported by CORVIS ST had changed in the follow-up.


These preliminary results show that CXL reduces eye rubbing in terms of frequency and duration of friction. This may be due to a decrease in corneal sensitivity secondary to transient alteration of the superficial corneal nerve plexus during surgery. Patients feel the benefit of this treatment on this point. According to CORVIS ST data, CXL does not appear to significantly harden the cornea in vivo. We postulate that the effectiveness of CXL in inhibiting the evolution of the Keratoconus is, at least partially, due to its inhibitory power on eye rubbing.

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