Corneal Endothelial Damage After Collagen
Cross-Linking Treatment
Nikhil S. Gokhale, MD

Purpose: To report a case of severe corneal endothelial damage after
collagen cross-linking treatment in a 37-year-old man with progressive
keratoconus with a corneal thickness of more than 400 mm.
Methods: After central epithelial debridement, the left cornea was
cross-linked for 25 minutes using dextran–riboflavin solution and
UV-A light of 370 nm with an irradiance of 3.0 mW/cm2. One month
after cross-linking treatment, the patient presented with massive
corneal edema. He was treated with 1% prednisolone and
carboxymethylcellulose 1% eyedrops 4 times a day for 3 months.
Specular microscopy with endothelial cell counting was performed
after resolution of the corneal edema 6 months after cross-linking.
Results: Despite intense treatment, a ring-shaped corneal scar remained,
and uncorrected visual acuity was finger counting. Cell density after
resolution was 1776 cells per square millimeter in the affected eye
compared with 2978 cells per square millimeter in the untreated felloweye.
Conclusions: Corneal thickness is not the only factor for corneal
endothelial damage after cross-linking procedure.
Key Words: collagen cross-linking, corneal endothelium, corneal
(Cornea 2011;30:1495–1498)