Rates of infectious keratitis and other ocular surface adverse events in corneal cross-linking for keratoconus and corneal ectasias performed in an office-based setting: a retrospective cohort study

Farhad Hafezi; Emilio A Torres-Netto; Leonard Kollros; Nan-Ji Lu; Nikki Hafezi; Cosimo Mazzotta; M Enes Aydemir; Mark Hillen

doi:10.1186/s40662-023-00354-1

Rates of infectious keratitis and other ocular surface adverse events in corneal cross-linking for keratoconus and corneal ectasias performed in an office-based setting: a retrospective cohort study

Eye Vis (Lond). 2023 Sep 1;10(1):36. doi: 10.1186/s40662-023-00354-1.

Authors

Farhad Hafezi^{1

2

3

4

5}, Emilio A Torres-Netto⁶, Leonard Kollros⁶, Nan-Ji Lu⁶, Nikki Hafezi⁶, Cosimo Mazzotta^{7

8

9}, M Enes Aydemir^{10

6}, Mark Hillen⁶

Affiliations

¹ Laboratory for Ocular Cell Biology, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland. farhad@hafezi.ch.
² ELZA Institute, Dietikon, Switzerland. farhad@hafezi.ch.
³ USC Roski Eye Institute, University of Southern California, Los Angeles, CA, USA. farhad@hafezi.ch.
⁴ Faculty of Medicine, University of Geneva, Geneva, Switzerland. farhad@hafezi.ch.
⁵ Dept. of Ophthalmology, University of Wenzhou, Wenzhou, China. farhad@hafezi.ch.
⁶ ELZA Institute, Dietikon, Switzerland.
⁷ Departmental Ophthalmology Unit, Alta Val d'Elsa Hospital, AUSL Tuscany South-East, Siena, Italy.
⁸ Postgraduate Ophthalmology School, University of Siena, Siena, Italy.
⁹ Siena Crosslinking Center, Monteriggioni, Siena, Italy.
¹⁰ Laboratory for Ocular Cell Biology, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland.

Abstract

Background: This study aimed to compare the complication rates of epithelium-off corneal cross-linking (epi-off CXL) performed in an office-based setting with those of epi-off CXL performed in an operating room.

Methods: A retrospective cohort study, comprising 501 consecutive epi-off CXL procedures, performed in a non-sterile procedure room without laminar flow ventilation at the ELZA Institute in Zurich, Switzerland, between November 2015 and October 2021, was conducted.

Results: No cases of postoperative infectious keratitis were observed, while sterile infiltrates occurred in 10 out of 501 (2.00%) patients, all of whom responded well to topical steroid therapy. Delayed epithelialization (> 7 days) occurred in 14 out of 501 (2.79%) patients. No other adverse events were noted.

Conclusions: Office-based epi-off CXL does not appear to be associated with an increased risk of complications when compared to operating room settings.

Keywords: Cornea; Corneal cross-linking; Epithelium-off; Infectious keratitis; Keratoconus; Office-based; Slit lamp; Sterile infiltrates.