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Fundamentals of Corneal Cross Linking

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Corneal Collagen Cross Linking

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Abstract

Efficient corneal cross linking (CXL) comprises three key ingredients: energy dose of the applied ultraviolet (UV) light, concentration or composition of riboflavin (vitamin B2), and oxygen. CXL obtains its relevance from the combination of UV light and riboflavin which triggers the polymerization (cross linking) process but requires available oxygen to be effective. In addition, side factors such as the hydration of the cornea, other molecules (e.g., Vitamin C), or the temperature during CXL can influence the reaction mechanism. Ultimately, the aim is to optimize control of the CXL process to improve the predictability of the CXL effect and to provide the best clinical outcome for patients. This chapter focuses on the infrastructure of CXL, starting with the history of CXL, going through the CXL procedure, and highlighting the role of scientists in creating an optimum treatment to stop the progression of keratoconus (KC). The biomechanics of the cornea are a keystone in this infrastructure; they are discussed in terms of future in vitro and in vivo applications to observe corneal shape changes in KC diagnostically versus computationally. Finally, the future of CXL is considered as a potential alternative to refractive correction.

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Authors and Affiliations

  1. School of Physics, University College Dublin, Room 202, Science Centre North Belfield, Dublin, Ireland

    Rebecca McQuaid MSc & Brian Vohnsen PhD

  2. IROC Science AG and Swiss Federal Institute of Technology, Zurich, Zurich, Switzerland

    Michael Mrochen PhD

  3. Department of Ophthalmology, Medical Faculty Carl GustavCarus, Technische Universität, Dresden, Germany

    Eberhard Spoerl MD, PhD

  4. Laboratory of Ocular Cell Biology, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland

    Sabine Kling PhD

  5. Ophthalmology & Visual Science; and Biomedical Engineering, The Ohio State University, Columbus, OH, USA

    Cynthia J. Roberts PhD

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  1. Rebecca McQuaid MSc
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  2. Michael Mrochen PhD
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  3. Brian Vohnsen PhD
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  4. Eberhard Spoerl MD, PhD
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  5. Sabine Kling PhD
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  6. Cynthia J. Roberts PhD
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Correspondence to Rebecca McQuaid MSc .

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Editors and Affiliations

  1. Ophthalmology Department, Damascus University, Damascus, Saudi Arabia

    Mazen M. Sinjab

  2. Wellington Eye Clinic, Dublin, Ireland

    Arthur B. Cummings

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McQuaid, R., Mrochen, M., Vohnsen, B., Spoerl, E., Kling, S., Roberts, C.J. (2017). Fundamentals of Corneal Cross Linking. In: Sinjab, M., Cummings, A. (eds) Corneal Collagen Cross Linking. Springer, Cham. https://doi.org/10.1007/978-3-319-39775-7_3

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