CXL Reduces Corneal Transplants?

Dutch eye doctors were interested in learning if cross-linking decreased the number of patients who undergo corneal transplants. Dr. Daniel Godefrooij, MD, an expert in outcomes and the economics of keratoconus, and his co-authors published the results of their study in the May issue of ACTA Ophthalmologica.

The Netherlands has a national organ transplant registry. In order to receive donor corneas, eye surgeons must complete a pretreatment form with their patient’s information, including diagnosis, age at the time of surgery, and vision testing results.

The authors chose a three year period (2005-07) before crosslinking was available in the Netherlands, and compared the number of keratoconus patients under the age of 50 who underwent keratoplasty (corneal transplant) compared to a three year period (2012-14) after cross linking became the standard procedure to treat progressive keratoconus. Age 50 was selected as the cut-off because this is the oldest age which CXL is performed in the Netherlands.

Historically, about 10-20% of keratoconus patients ultimately undergo a corneal transplant. If crosslinking is successful in reducing the need for transplant, other significant risks associated with the transplant surgery including grant rejection, grant failure, secondary glaucoma and cataract would also be reduced.

In the two three-year periods, the number of patients declined from 269 transplants to 201. This was a statistically significant decline. Other factors – the age at time of surgery and best corrected vision remained similar in the two time periods. The authors stated there was no reason to believe there were less patients with keratoconus diagnosed in the later time period, or that the indication for performing corneal transplants has changed. Even though the two procedures are different and not exchangeable treatments, the authors concluded that the availability and success of CXL for progressive keratoconus has resulted in an overall decrease in the number of patients who now undergo corneal transplants in the Netherlands. It will be interesting to see if these trends are seen in other countries.

Read this article in ACTA Ophthalmologica