Accelerated corneal crosslinking (CXL) procedure

Accelerated treatment improves keratoconus, BCVA with less pain at 24 months

Howard Larkin

Posted: Wednesday, January 25, 2017

Wei Aixinjueluo MD

Wei Aixinjueluo MD


Two years after treatment with an accelerated corneal crosslinking (CXL) procedure that leaves the epithelium intact, Japanese patients with progressive keratoconus showed improved best corrected visual acuity (BCVA) and reduced corneal steepening, Wei Aixinjueluo MD told the XXXIV Congress of the ESCRS in Copenhagen, Denmark.

Patients also had fewer complications associated with removing the epithelium in conventional CXL, such as pain, slow recovery, corneal haze, sterile infiltrates, said Dr Aixinjueluo, of The University of Tokyo Hospital, Japan.

The study involved 21 eyes of 15 patients with progressive keratoconus – 12 male and three female, ranging from 17 to 38 years of age. All had corneal thickness of 380 microns at the thinnest point. In the previous 24 months each had one or more sign of progression, defined as an increase of 1.0 dioptre or more in Kmax, spherical equivalent refraction or astigmatism, or a decrease in hard contact base curve of more than 0.1mm. Patients with Descemet’s membrane rupture, glaucoma, uveitis, severe dry eye, corneal infections, pseudophakia, systemic disease that could affect corneal healing, or were pregnant or lactating, were excluded.

Patients were treated with accelerated CXL (KXL, Avedro). After topical anaesthesia of 4.0% lidocaine, the corneal surface was treated with a 0.25% riboflavin solution supplemented with benzalkonium chloride, EDTA, trometamol and hydroxypropyl-methylcellulose (ParaCel, Avedro) for four minutes, and 0.25% riboflavin solution (VibeX, Avedro) for six minutes. Corneas were measured with handheld ultrasound, and if thinner than 380 microns at any point, distilled water applied until the minimum was satisfied.

UVA 370nm was applied at 30mW/cm² with continued application of 0.25% riboflavin for three minutes, delivering a total dose of 5.4J/cm². An optical antibiotic ointment ofloxacin 0.3% and bandage were applied for one day, and antibiotic drop 1.5% levofloxacin and corticosteroid 0.1% fluorometholone applied topically for one week.

No intraoperative or postoperative complications were observed, and all 21 eyes completed follow-up. At 24 months, mean BCVA improved from about 0.22 logMAR to about 0.08 (P=0.2). Kmax declined from a mean of about 59 dioptres to 55.5 (P=0.003) and average K from about 52 to 49 dioptres (P=0.02). Thinnest corneal readings also dropped significantly though central corneal thickness remained stable, as did endothelial cell density and intraocular pressure, Dr Aixinjueluo reported.

“Accelerated transepithelial CXL was safe and effective for progressive keratoconus with a reduced rate of complications and operative and postoperative discomfort related to epithelial removal,” she concluded.

Wei Aixinjueluo: