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Fewer Keratoplasties After CXL Adoption

Fewer Keratoplasties After CXL Adoption
Kris Asleson

In spring of 2015, the FDA granted approval of corneal cross-linking (CXL), for progressive keratoconus (KC), a condition which affects one out of every 2,000 Americans.

Many are wondering if this new treatment will lower the number of corneal transplants, or keratoplasties, which nearly 20% of patients need once the disease progresses to advanced stages.

According to data from the Dutch National Organ Transplant registry, a more favorable future is likely available to those who move forward with CXL to treat their condition.

Decrease in Transplants

A nationwide study in the Netherlands (which also supported data captured in an earlier, local study) found a 25% reduction in keratoplasties performed for KC during the three year period after the CXL process, compared to a similar period beforehand. In the Netherlands, there were 269 corneal transplants in eyes with KC during the first three year period; there were only 201 in the following three year time span.

“Give the observational nature of the study, we cannot be absolutely certain about the causal relationship between the number of cross-linking treatments and teh reduction in transplantations,” said lead author Daniel A. Godefrooij, MD, at the University Medical Center Utretcht, the Netherlands. “However, we did everything possible to test our assumptions.”

The three assumptions tested were:

  1. The lower number of keratoplasties was unlikely to be a result of simply less prevalence of KC
  2. That the indication for performing keratoplasty did not change between the two study periods
  3. That the preventive effect of CXL would be detectable within a few years

Better for Patients

Dr. Godefrooij also explained that with a greater number of cross-linking procedures performed and more time to observe patients after the procedures, the reduction of keratoplasties may be even more significant than what was revealed in this study. Either way, he said the ability to avoid the more invasive procedure of corneal transplantation is a serious benefit for patients.

The cherry on top? This new method  is accomplished using a procedure shown to be safe, effective, and non-invasive.

For more information, please visit the American Academy of Ophthalmology at