[Collagen cross-linking with riboflavin and UVA light]

Since 1998 collagen cross-linking is used for patients with progressive keratoconus. Today it can almost be considered as the standard therapy.

Patients with progressive keratoconus and minimal corneal thickness of 400 µm have been cross-linked within a study - (EK 310 499) approved by the ethical committee since 1998. An increase of the maximum K-value by ≥ 1 D within the last year, patient's statement of deteriorating visual acuity or the necessity of new contact len fitting more than once in 2 years were considered as progression.

The analysis includes 153 eyes of 111 patients with a minimal follow-up of 12 months and a maximum follow-up of 6 years. The keratectasia significantly decreased in the 1 (st) year by 2.28 D. The visual acuity improved significantly by at least one line or, respectively, remained stable (i. e., no line loss) in the 1st year in 73 %. The results remained stable over the next two years. Despite the low number of patients with a follow-up longer than 3 years and therefore limited statistical statement power, our results still indicate a long-term stabilisation or, respectively, improvement after collagen cross-linking. We saw no severe side-effects. Three patients with an exacerbated neurodermitis showed continuous progression of keratoconus and were cross-linked again.

To date there have been numerous promising publications on collagen cross-linking for keratoconus. The results of this study indicate that collagen cross-linking appears to be an effective therapeutic option for progressing keratoconus. Besides the clinical there are enormous economical and psychosocial benefits. Cross-linking is an out-patient, minimally-invasive, cost-effective treatment with minimal strain for the persons concerned.