Does Crosslinking Reduce the Need for Corneal Transplants for Keratoconus? It's Too Soon to Tell

Christopher J. Rapuano, MD


December 22, 2015

Does Corneal Collagen Cross-linking Reduce the Need for Keratoplasties in Patients With Keratoconus?

Sandvik GF, Thorsrud A, Raen M, Ostern AE, Saethre M, Drolsum L
Cornea. 2015;34:991-995


Corneal collagen crosslinking (CXL) with riboflavin and ultraviolet A light is a procedure that has been widely available around the world for about 5-10 years. Although it has many uses, including the treatment of recalcitrant corneal infections, the most common indication is to stop the progression of keratoconus.

One hope is that CXL will reduce the need for corneal transplantation in patients with keratoconus. However, because keratoconus is a slowly progressive disease, demonstrating a decrease in corneal transplantation for keratoconus after the widespread use of CXL has been difficult.

The authors of this study compared the numbers of corneal transplants performed for keratoconus between two time periods: 2005-2006 and 2013-2014. They began performing CXL for keratoconus in 2007; therefore, the first period was pre-CXL treatment. The authors felt that the second period was far enough from the start of CXL treatment that it would demonstrate a decrease in the number of grafts for keratoconus if CXL were, in fact, having an effect.

From 2005 to 2006, they performed 55 corneal transplants for keratoconus out of 137 total corneal transplants (40%). From 2013 to 2014, 26 of 231 total corneal transplants (11%) were for keratoconus. Both the absolute number and the percentage of transplants performed for keratoconus were decreased.

The investigators noted that the main reason for the increase in the total number of transplants in the second period was an increase in endothelial keratoplasties; therefore, the absolute number of transplants for keratoconus is probably a more valid metric. They also noted a trend toward fewer younger patients undergoing corneal transplantation and for more advanced disease in the second period compared with the first.

Sandvik and colleagues concluded that the reduction in the number of transplants was caused in great part by the introduction of CXL treatment.


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