Transient Corneal Thinning in Eyes Undergoing Corneal Cross-Linking

PURPOSE: To report the corneal thinning during and after corneal cross-linking (CXL). DESIGN: Prospective, nonrandomized, single-center observational study. METHODS: Thirty patients (30 eyes; 9 female, 21 male; age, 38 +/- 12 years) were consecutively scheduled for CXL between January 23 and July 6, 2009. Twenty-four eyes had progressive keratoconus, 2 had pellucid marginal degeneration, 3 eyes had progressive keratectasia after a LASIK operation, and 1 eye had pseudophakic bullous keratopathy. Riboflavin-ultraviolet A (UVA)-induced CXL included the instillation of 0.1% riboflavin drops for 30 minutes followed by riboflavin instillation combined with UVA irradiation for another 30 minutes. Corneal thickness was measured preoperatively, during CXL, and after 1 and 6 months using an ultrasound pachymeter. Changes in the endothelial cell count, corneal steepness, refraction, and visual performance are also given. RESULTS: On average, the corneas thinned 87 +/- 40 mu m (range, 37-206 mu m; 19% +/- 7%) during a 60-minute CXL treatment. In 1 patient, the cornea did not swell, even with hypotonic solution such that CXL would be safe. After 1 month, the corneal thickness was lower than the preoperative thickness, but after 6 months, the corneas had regained their original thicknesses. The endothelial cell count and corneal steepness were unchanged after CXL. The UCVA (uncorrected visual acuity) and BSCVA (best spectacle-corrected visual acuity) were improved 6 months after CXL. CONCLUSIONS: Corneal thickness decreases significantly during CXL, even to a level where the health of the endothelium and cornea is jeopardized. Visual performance is improved 6 months after CXL. (Am J Ophthalmol 2011;152:533-536. (C) 2011 by Elsevier Inc. All rights reserved.)