Intraocular Pressure Changes Following Corneal Cross-Linking in Patients With Keratoconus

PRÉCIS: This retrospective study found significantly elevated IOP measurements in eyes with keratoconus after CXL at postoperative months 1 and 3, but not after 4.5 months, compared with both baseline and untreated fellow eyes. PURPOSE: To evaluate intraocular pressure changes after corneal collagen cross-linking in patients with keratoconus and compare intraocular pressure measurements across tonometry methods. METHODS: A retrospective chart review was performed of 405 patients (405 index eyes and 218 untreated fellow eyes) who underwent cross-linking between January 1, 2012, and January 1, 2024, at Duke Eye Center. Preoperative and postoperative intraocular pressure measurements were collected at ~1 month, 3 months, and ≥4.5 months postoperatively. Generalized estimating equation models included time point, tonometry method (iCare, Tonopen, Goldmann applanation tonometry), corticosteroid use, age, sex, and race. Wilcoxon rank-sum and sign-rank tests were used for tonometry method sub-analyses. RESULTS: In treated eyes, intraocular pressure significantly increased at 1 month (2.2 mmHg increase, P =0.001) and remained elevated at 3 months (1.1 mmHg increase, P