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The Future of Corneal Cross-linking

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Corneal Collagen Cross Linking

Abstract

As corneal cross-linking (CXL) gains momentum worldwide, new advances and uses of CXL continue to emerge. In general, many of these developments are directed toward making the procedure more efficient, safe, and comfortable for the patient. A number of groups are evaluating the safety and efficacy of accelerated CXL treatments, which are accomplished by higher UV fluences or the use of deuterated water, for instance. A variety of transepithelial delivery systems, which enable the diffusion of riboflavin past an intact epithelium, have been described that could potentially avoid the morbidities associated with epithelial debridement. These systems include the use of penetration enhancers, microneedles, intrastromal channels, ultrasound, iontophoresis, and vacuum. Contact lens-assisted CXL has been developed to aid in the safe treatment of thinner corneas. At the same time, some groups have sought to demonstrate how disease states other than keratoconus (KC) and corneal ectasia may benefit from the technology. These diseases include the treatment of infectious keratitis (Photo-activated Chromophore for Keratitis – Corneal Cross-linking (PACK-CXL)) and corneal edema. Finally, significant investment has been made toward the correction of refractive error using CXL, as either an adjunct to laser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) (e.g., LASIK extra or LASIK-CXL), or as a means to directly alter the curvature of the cornea (Photorefractive Intrastromal Cross-linking (PiXL)) without the need for incisions or laser-based ablation of the stroma.

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Authors and Affiliations

  1. Department of Ophthalmology, VA Palo Alto Health Care System, Byers Eye Institute at Stanford, Palo Alto, CA, USA

    David Myung MD, PhD

  2. Cornea and Refractive Surgery Service, Byers Eye Institute, 2452 Watson Court, Palo Alto, CA, 94303, USA

    Edward E. Manche MD

  3. Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA

    Edward E. Manche MD

  4. Department of Medicine, University of Geneva, Geneva, Switzerland

    David Tabibian MD

  5. Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland

    David Tabibian MD

  6. Faculty of Medicine, University of Geneva, Geneva, Switzerland

    Farhad Hafezi MD, PhD

  7. Department of Ophthalmology, University of Southern California, Los Angeles, CA, USA

    Farhad Hafezi MD, PhD

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  1. David Myung MD, PhD
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  2. Edward E. Manche MD
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  4. Farhad Hafezi MD, PhD
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Correspondence to Edward E. Manche MD .

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

    Mazen M. Sinjab

  2. Wellington Eye Clinic, Dublin, Ireland

    Arthur B. Cummings

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Myung, D., Manche, E.E., Tabibian, D., Hafezi, F. (2017). The Future 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_9

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