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Collagen Crosslinking After Radial Keratotomy

Elbaz, Uri MD; Yeung, Sonia N. MD, PhD, FRCSC; Ziai, Setareh MD, FRCSC; Lichtinger, Alejandro D. MD; Zauberman, Noa Avni MD, MHA; Goldich, Yakov MD; Slomovic, Allan R. MD, FRCSC; Rootman, David S. MD, FRCSC

doi: 10.1097/ICO.0000000000000044
Clinical Science

Purpose: The aim of this study was to report the outcomes of corneal collagen crosslinking (CXL) after previous radial keratotomy (RK) in patients with decreasing visual acuity and/or diurnal visual fluctuations.

Methods: The charts of all patients who had undergone CXL because of a worsening corrected distance visual acuity (CDVA) and/or diurnal visual fluctuations after RK were reviewed retrospectively. Uncorrected distance visual acuity, CDVA, manifest refraction, and corneal topography were recorded preoperatively and at 1, 3, 6, and 12 months after the procedure.

Results: Nine eyes of 6 patients that had undergone an RK 15 to 23 years before the CXL were included in the study. In 5 patients (8 out of 9 eyes), discontinuation of diurnal visual fluctuation was reported between 6 and 12 months after the CXL. The mean uncorrected distance visual acuities pre and 12 months after the CXL were 0.7 logarithm of the minimum angle of resolution (logMAR) and 0.6 logMAR, respectively (P = 0.3). The mean CDVAs pre and 12 months after the CXL were 0.2 logMAR and 0.1 logMAR (P = 0.5), respectively. The mean average keratometry pre and 12 months after the CXL were 40.1 and 39.1 diopters (P = 0.06), respectively. The mean corneal astigmatism values pre and 12 months after the CXL were 2.3 and 1.9 diopters (P = 0.06), respectively. The mean manifest refraction spherical equivalents (MRSEs) before and 12 months after the CXL were +1.4 and +2.5 (P = 0.1), respectively.

Conclusions: CXL is a safe and effective method to restore corneal stability in eyes with a history of RK. However, some of the effect that was achieved at the 6-month visit was blunted at the 12-month visit. Therefore, a longer follow-up is necessary to validate these findings.

Department of Ophthalmology, Yonge-Eglinton Laser Center, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.

Reprints: Uri Elbaz, Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada (e-mail:

The authors have no funding or conflicts of interest to disclose.

Dr U. Elbaz is a recipient of the Schwartz Reisman Fellowship, Toronto, ON, Canada, for 2012 to 2013.

Received August 13, 2013

Accepted October 28, 2013

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.