Corneal crosslinking (CXL) may be able to reduce corneal neovascularization, and in turn, be a novel treatment option to improve graft survival after high-risk penetrating keratoplasty (PK), a study in Cornea suggests.

Neovascularization is the main risk factor for graft rejection after high-risk PK. Earlier research already shows the procedure’s success in reducing pathological corneal blood and lymphatic vessels and reducing the risk of graft rejection after high-risk PK experimentally in mice; now, new research shows promising results in humans.  

The retrospective case series included five patients with progressive corneal neovascularization and the need for high-risk PK due to graft rejection and/or keratitis who received CXL and PK between 2019 and 2020. CXL was performed before or in combination with PK, and researchers assessed the effect of CXL on neovascularization based on slit-lamp images. Patients were followed to determine the incidence of adverse effects and graft rejection.

In one patient, peripheral corneal CXL was performed first as a single procedure, followed by an additional peripheral CXL combined with PK. In all other cases, peripheral CXL was directly combined with PK.

None of the patients had any intraoperative or postoperative complications. Researchers found peripheral CXL resulted in a mean reduction of 70.5%±22.7% with no revascularization issues. Additionally, all transplants remained clear and without immune reactions with an approximate follow-up of 16 weeks.

The findings suggest peripheral CXL may be a new option to regress pathologic corneal blood vessels in patients and may be a new treatment option, especially in  high-risk patients before keratoplasty, the investigators note.