• News in Review

    Fewer Keratoplasties After CXL Adoption

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    Last spring, the FDA granted approval of corneal cross-linking (CXL) for progressive keratoconus (KC), which affects 1 in every 2,000 Americans.1 Will this new treatment decrease the number of corneal trans­plants (keratoplasties), which have been needed in up to 20% of patients whose disease progresses to advanced stages?1 Data from the Dutch National Organ Transplant registry suggest that there may be good news on the American horizon.2

    Marked decrease in transplants. A nationwide study in the Netherlands found a 25% reduction in keratoplas­ties performed for KC during the 3-year period after implementation of CXL (2012 through 2014) compared with a 3-year period before its introduction (2005 through 2007)—results that were consistent with an earlier local study by Sandvik et al.3 In the Netherlands, there were 269 corneal transplants in eyes with KC in the 3-year study period before introduction of CXL, but in the later study period, the number declined to 201.

    “Given the observational nature of the study, we cannot be absolutely certain about the causal relationship between the number of cross-linking treatments and the reduction in trans­plantations,” said lead author Daniel A. Godefrooij, MD, at the University Med­ical Center Utrecht, the Netherlands. “However, we did everything possible to test our assumptions,” he said. These were the 3 assumptions: that the lower number of keratoplasties was unlikely to be explained simply by a decrease in the prevalence of KC, that the indi­cation for performing keratoplasty did not change between the 2 study periods, and that the preventive effect of CXL would be detectable within several years.

    Better for patients. In fact, with a greater number of cross-linking pro­cedures performed and more time to observe patients following these proce­dures, said Dr. Godefrooij, it is possible that the reduction in keratoplasties could be even greater than that found in this study. Regardless, he said, the ability to avoid the more invasive pro­cedure of corneal transplantation—or to simply arrest the progression of cor­neal ectasia—is incredibly valuable for patients. And it’s accomplished using a procedure shown to be safe, minimally invasive, and effective.

    Annie Stuart


    1 National Keratoconus Foundation. Accessed June 28, 2016.

    2 Godefrooij DA et al. Acta Ophthalmol. Published online May 23, 2016. doi:10.1111/aos.13095.

    3 Sandvik GF et al. Cornea. 2015;34(9):991-995.


    Relevant financial disclosures: Dr. Godefrooij—None.


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