[Cross-linking: a new approach to bullous keratopathy].

Bullous keratopathy (BK) entails an irreversible corneal edema secondary to the failure of the endothelial pump. Its poor response tomedical treatment and its disabling clinical symptomatology has given rise to the appearance of a range of medical treatments, although the majority of patients end up requiring a corneal or endothelial transplant. Recently, cross-linking has began to be hailed as a new treatment for BK.1 This paper presents the experience in a 76-year-old patient with severe bilateral BK after phacoemulsification. The exploration revealed corneal edema with sub-epithelial bullae, intraocular pressure within the normal range and visual acuity (VA) of finger counting in both eyes, with greater involvement of the RE which exhibited an inferior trophic ulcer and pain (Figs. 1 and 2). The central corneal thickness (CCT) was of 900 m in RE and 570 m in OS. Due to the generally poor condition of the patient due to recent oncological history, cross-linking was suggested as a temporary alternative to keratoplasty because the symptoms persisted despite the topical treatment consisting of corticoids, hyperosmotic eyedrops, timolole 0.5, antibiotic prophylaxis and therapeutic contact lenses. After one session in the RE the stromal edema exhibited improvement as well as corneal transparency and the subepithelial bullae, the trophic ulcer, pain, VA (20/200) and CCT (680 m) (Fig. 2). A follow-up of 8 months was carried out during which time the RE VA was maintained and no local or systemic adverse effects were observed. The protocol utilized in these patient is themost frequently used protocol in the few papers that applied cross-linking as a treatment for corneal edema1,2: de-epithelization and 30min with prior instillation and every 5min of 0.1% riboflavin. Krueger et al. modified that technique with good results in vitro and in the patient, performing 2 corneal pockets