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Vienna 2018 Delegate Registration Programme Exhibition Virtual Exhibition Satellites 2018 Survey


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Specular microscopy changes following corneal cross-linking in thin corneas

Poster Details

First Author: Y.Cai UK

Co Author(s):    D. Gore   H. Ong   M. Leucci   B. Allan           

Abstract Details


Corneal cross-linking (CXL) in corneas thinner than 400 microns is widely considered a contraindication due to the risk of endothelial cell damage from ultraviolet A radiation. Some newer CXL devices are licensed to treat below this threshold. We report specular microscopy outcomes in thin corneas less than 400 microns.


Moorfields Eye Hospital, London


Patients were identified from a prospective electronic medical record database of all keratoconics aged 16 years of age and older undergoing accelerated CXL (pulsed irradiance 30 mW/cm2; energy 7.2 mJ/cm2). Eyes with a minimum pachymetry on Pentacam tomography of 399 microns or less were included for analysis. Specular microscopy (CellChek, Konan Medical USA Inc., Irvine, CA) was taken at baseline, 6 and 12 months employing automated image analysis. Up to three attempts were made to capture a specular image of sufficient quality for analysis. Both endothelial cell density (ECD) and coefficient of variation (CV) were recorded.


232 eyes (stage IV, mean [SD] K2 56.2 D [6.6]) met the inclusion criterion. Mean (SD) baseline minimum pachymetry was 383 (28) microns (range 352 – 399). In 160 eyes, specular image acquisition failed. In the remaining 72 eyes, baseline mean (SD) ECD was 2,748/mm2 (491), with a mean (SD) CV of 32 (19). At 12 months, mean (SD) ECD was 2,738/mm2 (639) with a mean (SD) CV of 34 (18), p = 0.62. No eyes clinically decompensated.


Accelerated CXL appears safe below 400 microns. However, poor specular microscopy acquisition and repeatability in very steep corneas may limit accurate assessment.

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