Corneal cross linking complications can pose a challenge. Patients with progressive Keratoconus when treated with cornea cross linking with riboflavin may face some side effects. The most common ocular adverse reactions were corneal opacity or haze, corneal folds or striae, superficial keratitis or punctate epitheliopathy.
There are three steps in performing Cornea Cross linking with riboflavin for Keratoconus eye treatment.The management of the complications arising from C3R procedure requires a cornea trained Keratoconus expert. A thorough understanding of the anatomy of the cornea and its physiology is required. The procedure involves three steps – a surgical, a chemical and a radiation step. Each portion can cause problems. The different side effects can interact further confusing the picture. A keratoconus surgeon has to be like Sherlock Holmes deciphering the clues to come up with a proper effective treatment regimen for complications.We need to study and observe each intervention to predict the complications.
Step 1: Epithelium removal leading to corneal cross linking complications
Epithelial defect is created by removing the epithelium layer. This can be done with chemical like alcohol or laser. There can be pain as corneal nerves are sensitized. Delauyed healing may be an issue. This can allow bugs to gain access to stroma and proliferate causing infection.
If laser is used we have to be aware that epithelium is thin over the cone. The laser may remove the thin epithelium and remove corneal tissue of the cone. This can result in a unstable cornea.
Step 2: Corneal cross linking complications related to riboflavin
Riboflavin is a vitamin and considered safe. Lack of penetration from irregular removal can allow the UV radiation to penetrate deeper. Cross linking will not occur effectively.
Step 3: UV radiation induced corneal cross linking complications
Sterile infiltrates: Non infectious inflammation induced by radiation. White blood cells are called into play and gather in groups.
Pic1. Sterile infiltrate seen on slit lamp
Corneal Edema : The shock to the cornea and epithelium removal can lead to retention of fluid in the cornea.
That is why FDA monitoring and approval is important. That way a patient can know the true incidence before deciding on the procedure. Risks benefits allow proper sight saving decisions to be made.
If you encounter Corneal cross linking complications and want a second opinion feel free to contact us.