Corneal crosslinking (CXL) with 18-mW/cm2 irradiance and 5.4-J/cm2 radiant exposure—early postoperative safety

  • Isaak FischingerEmail author
  • Theo G. Seiler
  • Karthiga Santhirasegaram
  • Moritz Pettenkofer
  • Chris P. Lohmann
  • Daniel Zapp



To investigate safety of accelerated corneal crosslinking during the first postoperative month.


In this retrospective study, 76 eyes of 60 patients with verified progressive keratectasia were enrolled in this study and followed for 1 month after accelerated CXL (18 mW/cm2 for 5 min, radiant exposure 5.4 J/cm2) (A-CXL(5*18)). Preoperatively, objective refraction, slit lamp inspection, and corneal tomography were performed. Early postoperative slit lamp examinations were performed on days 1 and 4. At 1 month, objective refraction, slit lamp inspection, and corneal tomography were performed.


Gender distribution was m:f = 55:21, OD:OS was 40:36, and the average age was 26.5 ± 8.6 years at surgery. Only 71 of the 76 eyes completed the 1-month follow-up, indicating a dropout rate of 6.6%. In 7.0% (n = 5), sterile infiltrates were observed; 5.6% of eyes (n = 4) showed delayed epithelial healing (> 4 days) in 2.8% (n = 2); an infection occurred and in 1 eye (1.4%), a stromal scar was detected; no other complications, neither a loss of two or more Snellen lines at 1 month postoperatively, were observed. As a risk factor for sterile infiltrates, thin preoperative pachymetry could be identified (p = 0.027).


This study revealed no difference in early postoperative safety between CXL using 18 mW/cm2 and standard corneal CXL. Thinner preoperative pachymetry could be identified predicting a higher rate of postoperative sterile infiltrates.


Corneal crosslinking Keratokonus Keratectasia Accelerated crosslinking 18 mW Sterile infiltrate 


Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria, educational grants, participation in speakers’ bureaus, membership, employment, consultancies, stock ownership or other equity interest, and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name the institution/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Ethical approval

For this type of study, formal consent is not required.

Supplementary material

417_2018_3978_MOESM1_ESM.pdf (2.8 mb)
ESM 1 (PDF 2819 kb).


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.The Klinik und Poliklinik für Augenheilkunde, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany
  2. 2.The Institut für Refraktive und Ophthalmo-Chirurgie (IROC)ZürichSwitzerland
  3. 3.The Inselspital BernUniversitätsspital BernBernSwitzerland

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