Modified corneal collagen crosslinking reduces corneal oedema and diurnal visual fluctuations in Fuchs dystrophy

Crosslinking of corneal collagen with riboflavin and ultraviolet-A irradiation (CXL) induces crosslinks within and between collagen fibres. CXL increases corneal biomechanical and biochemical stability,1 and is currently used clinically to treat keratectasia.2 3 CXL also significantly reduces the stromal swelling capacity.4 We investigated whether a modified CXL treatment protocol would be beneficial in early Fuchs dystrophy with various degrees of corneal oedema and diurnal variations in visual acuity. CXL was performed as published previously,2 with the following modification: in cases where the stroma was thicker than 450 μm after abrasion and 30 min of instillation of isoosmolar riboflavin solution, glycerol 70% solution was applied every 5 s for 2 min, and the central corneal thickness (CCT) was measured using ultrasound pachymetry (Tomey GmbH, Erlangen, Germany). Glycerol 70% solution was administered repeatedly until the target corneal thickness of 370–430 μm was reached. During irradiation (UV-X, Peschke Meditrade, Cham, Switzerland), CCT was monitored by ultrasound pachymetry …