Complications of Epithelium-Off Crosslinking for Keratoconus: A Single Institution Historical Experience.

PURPOSE: Large-scale studies of corneal collagen crosslinking (CXL) complications and risk factors in the United States are limited. We present a single institution's historical experience.

SETTING

Two large cornea practices at Wills Eye Hospital.

DESIGN

Retrospective single-center study.

METHODS

All patient encounters for epithelium-off CXL performed by eight physicians between January 1, 2018 and September 1, 2023 were identified. Exclusion criteria included follow-up period less than 3 months and indication for CXL other than keratoconus. Data extracted from electronic medical records included sociodemographic characteristics and clinical factors (including preoperative corneal scarring, corneal tomography parameters, and need for general anesthesia [GA]). Risk factors for complications were analyzed, including persistent epithelial defect (PED) lasting ≥2 weeks, infiltrate (sterile or infectious), and haze lasting ≥3 months.

RESULTS

833 eyes from 670 patients that received CXL via the KXL system (Glaukos, Burlington, MA) were identified for inclusion. Overall, 31 (3.7%) eyes had PED, 28 (3.4%) eyes had postoperative infiltrates, and 565 (67.8%) had corneal hazeIn multivariable analysis, PED was associated with use of GA (odds ratio [OR]=8.46, 95% confidence interval [CI]=2.23-26.27, p<0.001) and preoperative corneal scarring (OR=4.59, 95% CI=2.03-9.94, p<0.001). Corneal haze was associated with thicker baseline pachymetry (OR=1.004, 95% CI=1.001-1.008, p=0.024) and younger age (OR=0.98, 95% CI=0.97-0.99, p=0.014). No significant risk factors for corneal infiltrates were identified.

CONCLUSIONS

While CXL has low complication rates, PED is associated with use of GA as well as corneal scarring, while corneal haze is associated with thicker baseline pachymetry and younger age. These findings may guide post-CXL monitoring to further optimize outcomes.