[Collagen cross-linking with riboflavin and UVA light].

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

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.