Treatment of Painful Bullous Keratopathy with Accelerated Transepithelial Crosslinking
https://doi.org/10.18008/1816-5095-2025-4-821-827
Abstract
Purpose: tо evaluate the effectiveness and safety of a modified accelerated transepithelial corneal crosslinking (CXL) technique with intrastromal riboflavin injection for pain relief and reduction of corneal edema in patients with painful bullous keratopathy (BK) who are not candidates for keratoplasty.
Patients and methods. This single-center retrospective study analyzed outcomes in 15 patients (15 eyes) with painful BK (mean age 71.7 ± 8.4 years). The procedure consisted of two paralimbal intrastromal injections of 0.1% riboflavin (at 3 and 9 o’clock), followed by UV irradiation (5.4 J/cm2, 15 minutes) without epithelial removal. Postoperative followup lasted 9 months. Evaluations included symptom severity (0–4 scale), central corneal thickness (CCT), and intraocular pressure (IOP).
Results. Pain reduction was observed in all patients within the first days after surgery. In 60 % (9 patients), pain did not recur throughout the follow-up period (p < 0.032). CCT decreased from 885.5 ± 95.8 µm to 680.2 ± 99.5 µm at 9 months (p < 0.02), amounting to a mean reduction of 259.1 ± 122.0 µm. IOP remained stable (p > 0.05). No complications were recorded.
Conclusion. The proposed technique demonstrated a long-lasting analgesic effect, sustained reduction of corneal edema, and minimized complication risk due to the absence of epithelium removal. This method appears promising for the palliative treatment of painful BK in patients with contraindications to corneal transplantation.
Keywords
bullous keratopathy,
corneal crosslinking,
intrastromal injection,
riboflavin,
transepithelial method,
pain syndrome,
corneal edema
Supporting agencies: no author has a financial or property interest in any material or method mentioned
About the Authors
Kh. Khraystin
Krasnov Research Institute of Eye Diseases
Russian Federation
Russian Federation
Christian Hussam - PhD, senior researcher, Department of Pathology of Optical Media of the Eye.
Rossolimo str., 11 A, B, Moscow, 119021
G. A. Osipyan
Krasnov Research Institute of Eye Diseases
Russian Federation
Russian Federation
Osipyan Grigory A. - MD, head of Department of Pathology of Optical Media of the Eye.
Rossolimo str., 11 A, B, Moscow, 119021
A. V. Zatsev
Krasnov Research Institute of Eye Diseases
Russian Federation
Russian Federation
Zaitsev Aleksey V. - PhD, head of the Operating Unit, researcher.
Rossolimo str., 11 A, B, Moscow, 119021
M. Jourieh
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation
Russian Federation
Zhurieh Mohammad - postgraduate.
Bolshaya Pirogovskaya str., 2, building 4, Moscow, 119991
E. V. Evdokimova
Krasnov Research Institute of Eye Diseases
Russian Federation
Russian Federation
Evdokimova Ekaterina V. - postgraduate.
Rossolimo str., 11 A, B, Moscow, 119021
References
1. Gonçalves ED, Campos M, Paris F, Gomes JAP, de Farias CC. Ceratopatiabolhosa: etiopatogênese e tratamento. Arq Bras Oftalmol. 2008;71(6 SUPP):61–64. doi: 10.1590/S0004-27492008000700012.
2. Saim Khan M, Basit I, Ishaq M, Shakoor T, Yaqub A, Intisar R. Corneal Collagen Cross Linking (CXL) in treatmentof Pseudophakic Bullous Kаratopathy. Pakistan Journal of Medical Sciences Old Website. 2016;32(4):965–968. doi: 10.12669/PJMS.324.10138.
3. Ghanem RC, Santhiago MR, Berti TB, Thomaz S, Netto M V. Collagen crosslinking with riboflavin and ultraviolet-A in eyes with pseudophakic bullous keratopathy. J Cataract Refract Surg. 2010;36(2):273–276. doi: 10.1016/J.JCRS.2009.07.041.
4. Stuart AJ, Romano V, Virgili G, Shortt AJ. Descemet’s membrane endothelial keratoplasty (DMEK) versus Descemet’s stripping automated endothelial keratoplasty (DSAEK) for corneal endothelial failure. Cochrane Database Syst Rev. 2018;2018(6): CD012097. doi: 10.1002/14651858.CD012097.PUB2.
5. Kemer ÖE, Karaca EE, Oellerich S, Melles G. Evolving Techniques and Indications of Descemet Membrane Endothelial Keratoplasty. Turk J Ophthalmol. 2021;51(6):381. doi: 10.4274/TJO.GALENOS.2021.28227.
6. Musa M, Zeppieri M, Enaholo ES, Chukwuyem E, Salati C. An Overview of Corneal Transplantation in the Past Decade. Clin Pract. 2023;13(1):264. doi: 10.3390/CLINPRACT13010024.
7. Siu GDJY, Young AL, Jhanji V. Alternatives to corneal transplantation for the management of bullous keratopathy. Curr Opin Ophthalmol. 2014;25(4):347–352. doi: 10.1097/ICU.0000000000000062.
8. Lin HC, Wang YL, Chen GW, Yen CH. Corneal tattooing and anterior stromal puncture for treating symptomatic bullous keratopathy. Cornea. 2016;35(3):355–357. doi: 10.1097/ICO.0000000000000693.
9. Spoerl E, Huhle M, Seiler T. Induction of Cross-links in Corneal Tissue. Exp Eye Res. 1998;66(1):97–103. doi: 10.1006/EXER.1997.0410.
10. Wollensak G, Spoerl E, Seiler T. Riboflavin/ultraviolet-A-induced collagen crosslinking for the treatment of keratoconus. Am J Ophthalmol. 2003;135(5):620–627. doi: 10.1016/S0002-9394(02)02220-1.
11. Raiskup F, Spoerl E. Corneal Crosslinking with Riboflavin and Ultraviolet A. I. Principles. Ocul Surf. 2013;11(2):65–74. doi: 10.1016/J.JTOS.2013.01.002.
12. Santhiago MR, Randleman JB. The biology of corneal cross-linking derived from ultraviolet light and riboflavin. Exp Eye Res. 2021;202:108355. doi: 10.1016/j.EXER.2020.108355.
13. Wollensak G, Aurich H, Pham DT, Wirbelauer C. Hydration behavior of porcine cornea crosslinked with riboflavin and ultraviolet A. J Cataract Refract Surg. 2007;33(3):516–521. doi: 10.1016/J.JCRS.2006.11.015.
14. Steinberg J, Ahmadiyar M, Rost A, Frings A, Filev F, Katz T, Linke SJ. . Anterior and posterior corneal changes after crosslinking for keratoconus. Optometry and Vision Science. 2014;91(2):178–186. doi: 10.1097/OPX.0000000000000141.
15. Wollensak G, Aurich H, Wirbelauer C, Pham DT. Potential Use of Riboflavin/UVA Cross-Linking in Bullous Keratopathy. Ophthalmic Res. 2009;41(2):114–117. doi: 10.1159/000187630.
16. Yani EV, Seliverstova KE. Therapeutic possibilities for secondary epithelial-endothelial corneal dystrophy using a portable device for local collagen crosslinking. Russian Ophthalmological Journal. 2023;16(2):108–112 (In Russ.). doi: 10.21516/2072-00762023-16-2-108-112.
17. Marvanova LR. Еfficacy of Combined Treatment of Epithelial and Endothelial Corneal Dystrophy Using Corneal Crosslinking and Automated Posterior Lamellar Keratoplasty. Ophthalmology in Russia. 2019;16(1S):102–107 (In Russ.). doi: 10.18008/1816-5095-2019-1S-102-107.
18. Astakhov SYu, Novikov SA, Papanyan SS, Riks IA. Еvaluate the Effectiveness of Accelerated Collagen Crosslinking in the Treatment of Corneal Endothelial Decompensation. Ophthalmology in Russia. 2020;17(4):699–704 (In Russ.). doi: 10.18008/1816-5095-2020-4-699-704.
19. Choy BNK, Ng ALK, Zhu MM, Liu CC, Xu S, Lai JSM. Randomized Control Trial on the Effectiveness of Collagen Cross-linking on Bullous Keratopathy. Cornea. 2020;39(11):1341–1347. doi: 10.1097/ICO.0000000000002395.
20. Cordeiro Barbosa MMV, Barbosa JB, Hirai FE, Hofling-Lima AL. Effect of cross-linking on corneal thickness in patients with corneal edema. Cornea. 2010;29(6):613–617. doi: 10.1097/ICO.0B013E3181C296C2.
21. Arora R, Manudhane A, Saran RK, Goyal J, Goyal G, Gupta D. Role of Corneal Collagen Cross-Linking in Pseudophakic Bullous Keratopathy: A Clinicopathological Study. Ophthalmology. 2013;120(12):2413–2418. doi: 10.1016/J.OPHTHA.2013.07.038.
22. Sharma N, Roy S, Maharana PK, et al. Outcomes of corneal collagen crosslinking in pseudophakic bullous keratopathy. Cornea. 2014;33(3):243–246. doi: 10.1097/ICO.0000000000000004.
23. Hafezi F, Dejica P, Majo F. Modified corneal collagen crosslinking reduces corneal oedema and diurnal visual fluctuations in Fuchs dystrophy. British Journal of Ophthalmology. 2010;94(5):660–661. doi: 10.1136/BJO.2009.162479.
24. Krueger RR, Ramos-Esteban JC, Kanellopoulos AJ. Staged intrastromal delivery of riboflavin with UVA cross-linking in advanced bullous keratopathy: Laboratory investigation and first clinical case. Journal of Refractive Surgery. 2008;24(7):S730-6. doi: 10.3928/1081597X-20080901-17.
Review
For citations:
Khraystin Kh., Osipyan G.A., Zatsev A.V., Jourieh M., Evdokimova E.V. Treatment of Painful Bullous Keratopathy with Accelerated Transepithelial Crosslinking. Ophthalmology in Russia. 2025;22(4):821-827. (In Russ.) https://doi.org/10.18008/1816-5095-2025-4-821-827
Views:
39
Email this article 