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Outcomes of Corneal Collagen Crosslinking in Pseudophakic Bullous Keratopathy

Sharma, Namrata MD; Roy, Sangeeta MD; Maharana, Prafulla K. MD; Sehra, Sri V. MD; Sinha, Rajesh MD, FRCS; Tandon, Radhika MD, FRCOphth; Titiyal, Jeewan S. MD; Vajpayee, Rasik B. MS, FRCSEd, FRANZCO

doi: 10.1097/ICO.0000000000000004
Clinical Science

Purpose: The aim was to evaluate the outcomes of corneal collagen crosslinking (CXL) in symptomatic pseudophakic bullous keratopathy (PBK).

Methods: In a retrospective noncomparative, interventional case series, we reviewed the records of 50 eyes (50 patients) with symptomatic PBK who underwent CXL. Central corneal thickness (CCT), pain score, best corrected visual acuity (BCVA), and corneal transparency were recorded at baseline; at day 7, day 15; and 1, 3, and 6 months after the CXL.

Results: The mean pain score decreased from 8.1 ± 0.6 at presentation to 2.1 ± 0.7 on day 7 (P = 0.0001). A subsequent regression was seen in pain scores over 6 months (5.3 ± 1.5). The mean CCT decreased from a preoperative value of 724.8 ± 78.4 to 694.9 ± 77.9 μm by the end of the first month (P = 0.0001). The CCT remained stable at subsequent follow-up. The BCVA improved from logarithm of the minimum angle of resolution (log MAR) 2.0 ± 0.5 preoperatively to log MAR 1.8 ± 0.5 by the end of the first month (P = 0.001). The subsequent follow-up showed a progressive deterioration in the BCVA to the preoperative levels at 6 months. Corneal bullae recurred in 44% (22 eyes) at 6 months after an initial disappearance. A significant improvement in the BCVA and a lack of recurrence of bullae were significantly associated with a thinner CCT on presentation.

Conclusions: CXL in symptomatic PBK temporarily improves pain without providing long-term improvement in the BCVA. Case selection is important with more effect seen in patients with a thinner CCT at presentation.

Departments of Ophthalmology, *Cornea and Refractive Surgery Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India;

Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia; and

Royal Victorian Eye and Ear Hospital, Melbourne, Australia.

Reprints: Namrata Sharma, Cornea and Refractive Surgery services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110026, India (e-mail:

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

Received April 10, 2013

Accepted September 05, 2013

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