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Combined Corneal Cross Linking and Other Procedures: Indications and Application Models

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Corneal Collagen Cross Linking

Abstract

Corneal cross linking (CXL) has significant supporting evidence suggesting that it stabilizes keratoconus (KC) and increases corneal rigidity. Randomized clinical trials demonstrating this in a statistically significant manner would still be welcomed however.

Stabilizing KC rarely leads to significant improvement in the visual acuity or visual quality however. For this reason, CXL has been combined with other procedures that have a refractive effect or a shape-changing effect on the corneal topography. This chapter examines the different methods of CXL application where visual acuity and quality are also considered. Starting with transepithelial or epithelium-on (Epi-On) CXL techniques that lead to a much faster visual rehabilitation and a safer technique in terms of loss of lines of corrected distance visual acuity (CDVA) than the traditional methods going through all the various refractive options including excimer laser (PTK and topography-guided PRK), intrastromal corneal ring segments (ISCR), and thermal procedures, we have attempted to cover the range of CXL procedures that are more than or different to the original Dresden (epithelium-off; Epi-Off) CXL technique. Additionally, photorefractive intrastromal CXL (PiXL) is discussed, as are intraocular approaches and nonsurgical approaches such as orthokeratology in combination with CXL. Patients have become more demanding, and our medical colleagues have become more innovative in finding solutions that can provide both stability to the cornea and improvement in the visual functioning. We are grateful to an outstanding faculty that has contributed to this chapter.

The indications for CXL are expanding with time, and most of them are addressed in this book. This chapter is devoted to refractive indications of CXL, namely keratoconus (KC), pellucid marginal degeneration (PMD), and post-LASIK ectasia. Corneal infections are one of the medical indications of CXL, and will be dealt with in Chap. 9.

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Authors and Affiliations

  1. Wellington Eye Clinic, Dublin, Ireland

    Arthur B. Cummings FCS(SA), MMed(Ophth), FRCSEd

  2. Department of Ophthalmology, Beacon Hospital, Sandyford, Dublin, Ireland

    Arthur B. Cummings FCS(SA), MMed(Ophth), FRCSEd

  3. Ophthalmology Department, Damascus University, Damascus, Syria

    Mazen M. Sinjab MD, MSc, ABOphth, PhD, FRCOphth

  4. Faculty in Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear Infirmary, Waltham, MA, USA

    Kathryn M. Hatch MD

  5. Department of Ophthalmology, Harvard Medical School, Massachusetts Eye & Ear Hospital, Waltham, MA, USA

    Jonathan Talamo MD

  6. Department of Ophthalmology, Emory University, Emory Vision, Emory Eye Center, Atlanta, GA, USA

    Bradley Randleman MD

  7. Department of Ophthalmology, NYU Medical School, LaserVision. GR Clinical and Research Eye Institute, Athens, Greece

    Anastasios John Kanellopoulos MD

  8. Department of Research, LaserVision.gr Clinical and Research Institute, Athens, Greece

    George Asimellis PhD

  9. Ebsaar Eye Surgery Center, Dubai, United Arab Emirates

    Hani Sakla MB, BCh, MSc, MD, PhD & Wassim Altroudi MD

  10. Cornea Eye Institute, Cedars-Sinai Medical Center, UCLA, Los Angeles, CA, USA

    Yaron S. Rabinowitz MD

  11. Istanbul Eye Hospital, Istanbul, Turkey

    Aylin Kılıç MD

  12. Re:Vision, Rockville, MD, USA

    Roy Scott Rubinfeld MD, MA

  13. Re:Vision, Fairfax, VA, USA

    Roy Scott Rubinfeld MD, MA

  14. Ophthalmology, Georgetown University Medical Center, Washington, DC, USA

    Roy Scott Rubinfeld MD, MA

  15. Washington Hospital Center, Washington, DC, USA

    Roy Scott Rubinfeld MD, MA

  16. Department of Cornea and Refractive Surgery, Instituto de Olhos Renato Ambrosio, Rio de Janeiro, Brazil

    Renato Ambrósio Junior MD, PhD

  17. Ophthalmology, Alexandria University, Alexandria, Egypt

    Mohamed El-Kateb MD, PhD

  18. DV Consulting Services, Chelmsford, MA, USA

    Dale P. DeVore PhD

  19. Euclid Vision Systems, Chelmsford, MA, USA

    Dale P. DeVore PhD

  20. OB GYN, VCU, Richmond, VA, USA

    Michael A. Ross PhD

  21. George Washington University, Washington, DC, USA

    Michael A. Ross PhD

  22. Euclid Systems Corporation, Richmond, VA, USA

    Michael A. Ross PhD

  23. Euclid Vision Systems, Vienna, VA, USA

    Bruce H. De Woolfson PhD

  24. MedStar Georgetown University Hospital, Washington, DC, USA

    Olivia Dryjski MD

  25. MedStar Washington Hospital Center, Washington, DC, USA

    Olivia Dryjski MD

  26. Stulting Research Center, Woolfson Eye Institute, Sandy Springs, GA, USA

    R. Doyle Stulting

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  1. Arthur B. Cummings FCS(SA), MMed(Ophth), FRCSEd
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Corresponding author

Correspondence to Arthur B. Cummings FCS(SA), MMed(Ophth), FRCSEd .

Editor information

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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Cummings, A.B. et al. (2017). Combined Corneal Cross Linking and Other Procedures: Indications and Application Models. In: Sinjab, M., Cummings, A. (eds) Corneal Collagen Cross Linking. Springer, Cham. https://doi.org/10.1007/978-3-319-39775-7_4

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