Permanent Corneal Haze After Riboflavin-UVA-induced Cross-Linking in Keratoconus

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Abstract
Purpose: Retrospective evaluation of haze development after riboflavin-ultraviolet (UV) A-induced corneal collagen cross-linking (CXL). Methods: One hundred sixty-three eyes of 127 patients with stage 1–3 keratoconus according to Krumeich's classification were included in this retrospective analysis. Follow-up was 1 year. Preoperatively and at all follow-up examinations uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), slit-lamp microscopic findings, corneal topography, and corneal thickness were recorded. Results: At 1 year after CXL, 149 (91.4%) eyes of 114 patients had a clear cornea without stromal haze (control group), whereas 14 eyes (8.6%) of 13 patients developed clinically significant stromal haze (haze group). Preoperatively, the mean keratometry (K) value of the apex was 62.1±13.8 diopters (D) in the control group and 71.1±13.2 D in the haze group ( P =.02). The mean corneal thickness before the procedure was 478.1±52.4 µm in the control group and 420.0±33.9 µm in the haze group ( P =.001). Uncorrected visual acuity and BSCVA, which were similar between groups preoperatively ( P =.59 and P =.75, respectively), were improved in the control group ( P =.023 and P =.001, respectively), but reduced in the haze group ( P =.012 and P =.004, respectively) postoperatively. Conclusions: The parameters defining the stage of keratoconus, such as K-value and corneal thickness, could be considered predicting factors for possible development of corneal haze after riboflavin-UVA-induced CXL. Advanced keratoconus should be considered at higher risk of haze development after CXL due to low corneal thickness and high corneal curvature. [ J Refract Surg . 2009;25:S824–S828.]