Late-Onset Deep Stromal Scarring After Riboflavin–UV-A Corneal Collagen Cross-Linking for Mild Keratoconus | Cornea | JAMA Ophthalmology | JAMA Network
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Small Case Series
March 14, 2011

Late-Onset Deep Stromal Scarring After Riboflavin–UV-A Corneal Collagen Cross-Linking for Mild Keratoconus

Author Affiliations

Author Affiliations: Singapore Eye Research Institute (Drs L. S. Lim, Beuerman, L. Lim, and Tan); Singapore National Eye Centre (Drs L. S. Lim, L. Lim, and Tan); and Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore (Dr Tan), Singapore.

Arch Ophthalmol. 2011;129(3):360-371. doi:10.1001/archophthalmol.2011.23

Riboflavin–UV-A corneal collagen cross-linking (CXL) is a new technique that aims to arrest keratoconus progression. Riboflavin adsorbed to corneal stromal collagen fibers is activated by UV-A light, with the formation of cross-links between collagen fibrils that confer greater corneal rigidity.1

Initial clinical experience suggested that the technique was safe, but stromal haze formation is a complication that is increasingly being recognized.2-4 Herrmann et al2 described a case of transient subepithelial haze that resolved with topical steroids. Of greater concern, Raiskup et al3 and Mazzotta et al4 have described permanent stromal haze after CXL, with an incidence rate up to 8.6%.3 In both of these articles, the haze was relatively mild and occurred in eyes with advanced keratoconus.

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