Intense Early Flattening After Corneal Collagen Cross-linking

Abstract

PURPOSE: To report two cases of significant flattening after corneal cross-linking (CXL) for keratoconus and discuss its potential explanations and implications. METHODS: Observational case report. RESULTS: One year after standard CXL protocol (3 mW/cm(2) for 30 minutes and total energy of 5.4 J/cm(2)), a 28-year-old woman presented a flattening of greater than 14 diopters and a 14-year-old boy presented a flattening of 7 diopters. CONCLUSIONS: Although rare, a significant flattening effect may occur during the first year after CXL, probably related to intense wound healing, increase in corneal elasticity, CXL effective depth, and central cone location. These cases suggest the necessity of a patient-specific approach and a better understanding regarding the actual mechanism behind its potent effect.