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Marked remodelling of the anterior corneal surface following collagen cross-linking with riboflavin and UVA
  1. Farhad Hafezi1,2,
  2. Tobias Koller3,
  3. Paolo Vinciguerra4,
  4. Theo Seiler2
  1. 1Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland
  2. 2IROC, Institute for Refractive and Ophthalmic Surgery, Zurich, Switzerland
  3. 3Private practice, Dietikon, Switzerland
  4. 4Department of Ophthalmology, Istituto Clinico Humanitas, Milano, Italy
  1. Correspondence to Professor F Hafezi, Department of Ophthalmology, Geneva University Hospitals, Rue Alcide-Jentzer 22, 1211, Geneva 14, Switzerland; farhad{at}hafezi.ch

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Corneal collagen cross-linking with riboflavin/ultraviolet A (CXL) is a method for the treatment of progressive keratectasia.1 2 In 60% of patients, CXL leads to arrest of progression, and in 40%, even a regression of Kmax values is observed.2 Here, we report three cases that did not display regression but rather displayed a massive remodelling with Kmax reduction of up to 9.5 dioptres (D), accompanied by formation of a deep stromal opacity and a distinct increase in best spectacle-corrected visual acuity (BSCVA).

Methods

Three eyes of three patients with progressive keratoconus were included in this interventional case series. Progression was defined as an increase in Kmax>1.0 D within 12 months.3 Pre- and postoperative examinations included corneal topography (Keratograph C, Oculus, Wetzlar, Germany), Scheimpflug imaging (Pentacam, Oculus, Wetzlar, Germany) and slit-lamp examination. CXL was performed as published previously.4

Representative case

For an overview of corneal characteristics, please refer to table 1.

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Table 1

Corneal parameters before and after cross-linking with riboflavin/ultraviolet A (CXL)

A 27-year-old man (case 1) was referred to us for bilateral keratoconus in April 2007. Previous topographies …

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