Background Primary corneal collagen cross-linking (CXL) stabilises 96% of progressive keratoconus. There is limited evidence for the treatment of choice when this fails. We present 10 years of repeat CXL and compare with our published experience of primary CXL to (1) identify perioperative risk factors of primary CXL failure and (2) demonstrate the safety and efficacy of repeat CXL.
Methods Patients undergoing repeat accelerated epithelium-off CXL at St James’s University Hospital, Leeds, UK January 2012–August 2022 were identified through electronic patient record, and compared with a previously published cohort of primary CXL patients at the same site.
Results Twenty-one eyes underwent repeat CXL. The mean interval between primary and repeat CXL treatments was 47.1 months (SD 22.5). Twenty (95%) eyes stabilised after repeat CXL at a mean follow-up of 29.9 months. These cases were compared with 151 cases of primary CXL from our previous study. Patients failing primary CXL were significantly younger (21.3 years (SD 7.0) vs 26.7 years (SD 6.5), p=0.0008). Repeat CXL and primary CXL induced a similar amount of flattening of Kmax (−1.2 D (SD 3.9) vs −0.7 D (SD 4.4), p=0.22). A small, but clinically insignificant, improvement in best-corrected visual acuity was found in the repeat CXL group (−0.04 (SD 0.17) vs −0.05 (SD 0.13), p=0.04). No complications of repeat CXL were noted.
Conclusion Younger age may be associated with failure of primary CXL. Repeat CXL is an effective and safe treatment for progressive keratoconus despite primary CXL.
- Treatment Surgery
Data availability statement
Data are available on reasonable request. Data are available on reasonable request. Additional statistics can be found in online supplemental material.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
DM and AO are joint first authors.
Contributors DM is the guarantor. The following authors were responsible for conception and design of the work as well as the acquisition, analysis, and interpretation of data for the work: DM, AO and SA. The following authors were responsible for drafting the work and revising it critically for important intellectual content: DM, AO, SA, SH, CO and AD. The following authors were responsible for final approval of the version to be published: DM, AO, SA, SH, CO and AD. The following authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: DM, AO, SA, SH, CO and AD.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.