Complications after Corneal Cross-Linking

Purpose: The introduction of corneal cross-linking was associated with great expectations from patients as well as ophthalmologists. Previous results indicate that corneal cross-linking can slow down, stabilise or even reverse the progression of corneal ectasia in patients with keratoconus as well as in patients with ectasia after excimer laser ablations. We now describe our own experience with different protocols for corneal cross-linking and put these into perspective with the existing literature. Methods: We undertook a retrospective analysis of all of our corneal cross-linking treatments from January 2007 to July 2014 using different protocols. In addition, we provide an overview of the literature regarding complications of corneal cross-linking. Results: In our patient cohort we observed sterile infiltrates, transient cloudy opacifications, diffuse lamellar keratitis and a mycotic infection leading to corneal scarring. Moreover, even after transepithelial corneal cross-linking with different protocols, we have observed pain perception and epithelial disruption. At present there are few reports about infections or endothelial damage in the literature, however, induction of neoplasia is described. The incidence of complications appears to be low. Conclusion: Corneal cross-linking appears to have a high success rate and a low complication rate. Endothelial damage seems to be a far smaller problem than initially suspected. However, prospective studies with long-term follow-up are still lacking and it remains to be seen whether more cases of neoplasia following cross-linking will be reported. In our literature research we found no reports on re-treatments. Similarly, we found no study other than some case reports on keratoplasty after cross-linking. In view of rapidly changing treatment protocols further trials are warranted to monitor the benefits and complications of these modifications.