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Updated: Mar 28, 2026
Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Superficial corneal crosslinking during laser in situ keratomileusis
Theo G Seiler1, Isaak Fischinger1, Tobias Koller1
1From the Institut für Refraktive und Ophthalmo-Chirurgie (T.G. Seiler, Fischinger, Koller, Derhartunian, T. Seiler), Zürich, Switzerland and the Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der Isar (T.G. Seiler, Fischinger), Technische Universität München, München, Germany.
Purpose:
To determine the safety of superficial corneal crosslinking after laser in situ keratomileusis (LASIK).
Setting:
Institut für Refraktive und Ophthalmo-Chirurgie, Zurich, Switzerland.
Design:
Prospective study.
Methods:
Eyes with an ectasia risk score of 2 or higher were treated with standard LASIK (90 μm flap) for myopia correction, after which a rapid corneal crosslinking was performed in the interface (riboflavin 0.5% for 2 minutes, 9 mW/cm(2) for 5 minutes) (Group 1). The follow-up was up to 1 year. The prevalence of complications was statistically compared with that in a group of eyes matched regarding age, sex, and attempted refractive correction that were treated with standard LASIK only (Group 2).
Results:
One month postoperatively, 5 eyes in Group 1 lost 1 line of corrected distance visual acuity (CDVA) compared with 1 eye in Group 2 (P < .05). One year postoperatively, all eyes regained their preoperative CDVA, indicating a complication rate of less than 5%. The refractive success was identical in both groups. Early postoperative complications such as erosions (16%), diffuse lamellar keratitis (DLK) stage 1 (38%), and DLK stage 2 (5%) were statistically significantly more frequent after superficial corneal crosslinking, leading to a statistically significantly reduced uncorrected distance visual acuity at 1 month (P < .001).
Conclusions:
Based on 1-year results, superficial corneal crosslinking might be considered a safe adjunct to LASIK, with a delayed visual rehabilitation and a higher prevalence of transient side effects. It is not proved whether superficial corneal crosslinking can prevent iatrogenic keratectasia.
Financial Disclosure:
No author has a financial or proprietary interest in any material or method mentioned.
