DOI: 10.25881/20728255_2022_17_4_S1_63


Kornilovsky I.M., Gilya A.P., Khatataev R.R.

Pirogov National Medical and Surgical Center, Moscow


The paper considers the criteria for the safety and effectiveness of various methods of corneal crosslinking. To do this, we analyzed literature data on the complications of corneal crosslinking and our own results of preventive (590 operations) and therapeutic (110 operations) excimer laser corneal crosslinking in terms of 1 month to 9 years. A comprehensive ophthalmological examination, OCT, densitometry, and assessment of the state of the cornea according to optical scanning data in the visible and infrared ranges were performed. Clinically significant complications of corneal crosslinking were hydrops, infectious corneal ulcer, sterile infiltrates, and corneal opacities. The above complications were not observed during prophylactic and therapeutic excimer laser corneal crosslinking. Observations have shown that the criteria for the effectiveness of therapeutic crosslinking of the cornea should be considered stabilization or improvement of keratometric parameters. The main efficacy criteria for preventive crosslinking in laser refractive corneal surgery were the absence of deviations from the target refraction, complete restoration of corneal transparency, and stable keratometric parameters. The safety of one or another crosslinking technique was evidenced by the absence of corneal complications in the early and long-term follow-up periods.

Keywords: crosslinking, cornea, complications, safety, efficacy.


1. Kymionis GD, Bouzoukis DI, Diakonis VF, Portaliou DM, Pallikaris AI, Yoo SH. Diffuse lamellar keratitis after corneal crosslinking in a patient with post laser in situ keratomileusis corneal ectasia. J Cataract Refract Surg 2007;33:2135-2137.

2. Mazzotta C, Balestrazzi A, Baiocchi S, Traversi C, Caporossi A. Stromal haze after combined riboflavin‑UVA corneal collagen cross-linking in keratoconus: In vivo confocal microscopic evaluation. Clin Exp Ophthalmol 2007;35:580-582

3. Koller T, Mrochen M, Seiler T. Complication and failure rates after corneal crosslinking. J Cataract Refract Surg 2009;35:1358-1362.

4. Faschinger C, Kleinert R, Wedrich A. Corneal melting in both eyes after simultaneous corneal cross linking in a patient with keratoconus and Down syndrome. Ophthalmologe 2010;107:951-5.

5. Labiris G, Kaloghianni E, Koukoula S, Zissimopoulos A, Kozobolis VP. Corneal melting after collagen cross linking for keratoconus: A case report. J Med Case Rep 2011;5:152.

6. Lim LS, Beuerman R, Lim L, Tan DT. Late onset deep stromal scarring after riboflavin UV A corneal collagen cross linking for mild keratoconus. Arch Ophthalmol 2011;129:360-2.

7. Ghanem RC, Netto MV, Ghanem VC, Santhiago MR, Wilson SE. Peripheral sterile corneal ring infiltrate after riboflavin UVA collagen cross linking in keratoconus. Cornea 2012;31:702-5.

8. Arora R, Jain P, Gupta D, Goyal JL. Sterile keratitis after corneal collagen crosslinking in a child. Cont Lens Anterior Eye 2012;35:233-5.

9. Abbouda A, Abicca I,Alió JL. Infectious keratitis following corneal crosslinking: A systematic review ofreported cases: Management, visual outcome, and treatment proposed. Semin Ophthalmol. 2016;31:485-91.

10. Kim BZ, Jordan CA, McGhee CNJ, Patel DV. Natural history of corneal haze after corneal collagen crosslinking in keratoconus using Scheimpflug analysis. J Cataract Refract Surg 2016;42:1053-9.

11. Chiu HH, Sade S, Chew HF. Corneal melt following collagen crosslinking and topography guided customized ablation treatment for keratoconus. Can J Ophthalmol 2017;52:e88-91.

12. Chanbour W, Mokdad I, Mouhajer A, Jarade E. Late onset sterile peripheral ulcerative keratitis post corneal collagen crosslinking. Cornea 2019;38: 338-43.

13. Prabhakar G, Panickar N, Reddy J, Sivasubramaniam S, Singh A. Severe focal stromal degeneration up to Descemet membrane after corneal collagen cross linking. Indian J Ophthalmol 2020;68:224-6.

14. Agarwal R, Jain P, Arora R. Complications of corneal collagen cross-linking. Indian J Ophthalmol 2022;70:1466-74.

15. Müller P.L., Loeffler, K.U., Messmer E., Holz, F.G., Perdikakis G., Kohlhaas,M., Herwig-Carl, M.C. Histological Corneal Alterations in Keratoconus After Crosslinking—Expansion of Findings, Cornea,2020 ;39(3) 333-341.

16. Koller T., Mrochen M., PhD, Seiler T. Complication and failure rates after Corneal Cross-Linking. J Cataract Refract Surg., 2009; 35:1358–1362.

17. Kornilovskiy I.M., Kasimov E.M., Sultanova A.I., Burtsev A.A. Laser-induced corneal cross-linking upon photorefractive ablation with riboflavin. Clin. Ophthalmol. 2016; 10: 587-592.

18. Kornilovskij I.M. Primenenie inducirovannogo jeksimerlazernoj abljaciej vtorichnogo izluchenija dlja krosslinkinga v refrakcionnoj hirurgii rogovicy. Kataraktal’naja i refrakcionnaja hirurgija. 2017; 17 (3): 33-40. (In Russ.)

19. Kornilovskiy I.M. “Photorefractive Keratectomy with Protection from Ablation-Induced Secondary Radiation and Cross-linking Effect”. EC Opthalmology 10.7 (2019): 563-570.

20. Kornilovskij I.M., Sultanova A.I., Burcev A.A. Fotoprotekcija riboflavinom s jeffektom krosslinkinga pri fotorefrakcionnoj abljacii rogovicy. Vestnik oftal’mologii. 2016; 132 (3): 37-42. (In Russ.)

21. Kornilovskiy I.M. Photorefractive Keratectomy with Protection from Ablation-Induced Secondary Radiation and Cross-linking Effect. EC Ophthalmology. 2019; 10 (70): 563-570.

22. Kornilovskiy I.M. Prophylactic and Therapeutic Laser-Induced Corneal Crosslinking. EC Ophthalmology. 2020; 11(12):74-82.

23. Kornilovskiy I.M. Application of Pulsed Laser Radiation of the Fa Ultraviolet Range for Corneal Crosslinking. Acta Scientific Ophthalmology.2021; 4(4):51-55.

24. Doors M., Tahzib N.G., Eggink F.A., et al. Use of anterior segment optical coherence tomography to study corneal changes after collagen crosslinking. Am. J. Ophthalmol., 2009;148:844–851.e2. DOI: 10.1016/j.ajo.2009.06.031.

25. Ng A.L.K., Chan T.C.Y., Lai J.S.M. and Cheng A.C.K. Comparison of the central and peripheral cornel stromal demarcation line depth in conventional versus accelerated collagen cross-linking. Cornea, 2015;34(11): 1432–1436.

26. Kornilovskiy I.M. Reassessment of the Clinical Significance of the Demarcation Line in the Corneal Stroma in Crosslinking. Ophthalmology Research: An International Journal , 2022;17(3): 33-41, Article no.OR.9131.

For citation

Kornilovsky I.M., Gilya A.P., Khatataev R.R. Safety and efficiency criteria of corneal crosslinking in laser refractive corneal surgery. Bulletin of Pirogov National Medical & Surgical Center. 2022;17(4,supplement):63-66. (In Russ.)