Mechanical epithelial removal followed by corneal collagen crosslinking in progressive keratoconus: Short-term complications

ÇAĞIL N., SARAÇ Ö., Cakmak H. B., Can G., Can E.

Journal of Cataract and Refractive Surgery, vol.41, no.8, pp.1730-1737, 2015 (SCI-Expanded) identifier identifier identifier


© 2015 ASCRS and ESCRS.Purpose To compare the complications occurring within the first 3 months of corneal collagen crosslinking (CXL) performed with mechanical or transepithelial phototherapeutic keratectomy (PTK) epithelial removal in keratoconus patients. Setting Yildirim Beyazit University Ataturk Training and Research Hospital, Ankara, Turkey. Design Nonrandomized retrospective clinical study. Methods Eyes of consecutive progressive keratoconus patients who had PTK or mechanical epithelial removal followed by CXL were included. All patients were examined regularly until epithelial healing. Detailed ophthalmologic examinations were performed preoperatively and 1 and 3 months postoperatively. Results The study comprised 499 eyes (302 patients) that had transepithelial PTK (Group 1, 153 eyes) or mechanical epithelial removal (Group 2, 256 eyes) followed by CXL. Delayed epithelial healing occurred in 15.0% of eyes in Group 1 and 3.5% of eyes in Group 2 (P =.001). Epithelial hypertrophy occurred in 24.8% of eyes and 3.5% of eyes, respectively (P =.001). Salzmann-like epithelial nodules (2.6%), epithelial herpetic keratitis (1.9%), anterior uveitis (1.9%), and elevated intraocular pressure (1.9%) occurred in Group 1 only and infective keratitis (0.8%) in Group 2 only. Marked stromal edema and peripheral sterile infiltrates occurred at similar rates in both groups (P =.567 and P =.479, respectively). Grade 1+ corneal haze was significantly high in Group 2. Grade 2+ and 3+ haze was significantly high in Group 1 (P =.001). Conclusions Ocular surface healing disorders were the most common early complications of CXL. Short-term complications were higher with the transepithelial PTK epithelial removal technique than with mechanical epithelial removal. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.