Assessment of Corneal Crosslinking for the Treatment of Corneal Neovascularization With and Without Associated Infection

Purpose: To evaluate investigational use of corneal crosslinking (CXL) to treat corneal neovascularization (CNV) with or without concomitant infection. Methods: This prospective, single-center study assessed investigational use of epithelium-off CXL with 0.1% riboflavin/20% dextran ophthalmic solution to treat various scenarios of CNV with standard 30-minute or accelerated 10-minute irradiation. Results: The CXL treatment was investigated for 38 CNV scenarios in 37 eyes of 35 participants (2 bilateral) and was repeated once in 2 eyes and twice in 1 eye. Treatment was considered successful in 24 cases, partially successful in 1 case, and unsuccessful in 8 cases; 2 cases were lost to follow up and 3 developed complications unrelated to the CXL that precluded efficacy evaluation. The CXL was considered successful in all 4 cases treated for CNV with melting and/or cheese wiring of the recipient cornea postkeratoplasty, in 7 of 9 cases with active infection, in 5 of 10 cases treated in conjunction with penetrating keratoplasty, in 3 of 4 cases treated in conjunction with lamellar keratoplasty or wound revision, and in 6 of 11 cases without associated infection or surgery. Conclusions: Investigational use of CXL can contribute to CNV regression in the following scenarios: postkeratoplasty corneal melting and suture cheese wiring, infectious keratitis, and combined with keratoplasty. However, it has limited, if any, benefit in treating CNV in situations where the stimulus for CNV is not eliminated, such as ongoing infection or chronic conditions such as limbal stem cell dysfunction.