Abstract:

Objective To report the main complications of progressive keratoconus treated by epithelial removal(ER) corneal collagen crosslinking(CXL). Design Retrospective case series. Participants 40 patients with progressive keratoconus admitted to Tongren Hospital from January to December 2015.  Methods Retrospective analysis was performed on the pre and post-operative data of the patients, whose thinnest cornea thickness was 375-450 μm prior to surgery, and treated by epithelial removal corneal collagen crosslinking (CXL). The ocular pain and foreign body sensation were assessed by questionaire and the anterior segment at 1 day, 3 days, 1 week, 1 month after operation. Main Outcome Measures The pre and post-operative visual acuity (VA), intraocular pressure, ocular pain and recovery of corneal epithelia of each patient. Results On the first day after operation, patients complained obvious ocular pain and foreign body sensation. The scores was 3.19±0.37 and 3.15±0.23 respectively. Examination showed epithelial defects on the corneas of patients. There was still moderate foreign body sensation  (2.23±0.43) and painfulness (2.23±0.32) 3 days after surgery, and the epithelial defects were fairly recovered. There was only slight foreign body sensation (0.23±0.07) and painfulness (0.22±0.11) 7 days after surgery, and the epithelial defects were mostly recovered. There was no foreign body sensation and painfulness two weeks later. At 6-month follow up visit, we found that keratoconus was well controlled with no advancement in all 40 patients, among whom 30 cases found their uncorrected visual acuity improved and 35 cases had their corrected visual acuity improved. No such complications as corneal infection, scaring, ulceration or epithelial defect occurred. Conclusion Corneal collagen crosslinking is an effective treatment for progressive keratoconus. It is crucial for clinical management that we deal with patients’ pain at early stage and corneal epithelial defect. (Ophthalmol CHN, 2017, 26: 333-336)

Key words: corneal collagen crosslinking, progressive keratoconus, complications