Recent advances in corneal collagen cross-linking

Abstract

Corneal collagen cross-linking has become the preferred modality of treatment for corneal ectasia since its inception in late 1990s. Numerous studies have demonstrated the safety and efficacy of the conventional protocol. Our understanding of the cross-linking process is ever evolving, with its wide implications in the form of accelerated and pulsed protocols. Newer advancements in technology include various riboflavin formulations and the ability to deliver higher fluence protocols with customised irradiation patterns. A greater degree of customisation is likely the path forward, which will aim at achieving refractive improvements along with disease stability. The use of cross-linking for myopic correction is another avenue under exploration. Combination of half fluence cross-linking with refractive correction for high errors to prevent post LASIK regression is gaining interest. This review aims to highlight the various advancements in the cross-linking technology and its clinical applications.

Figure 1

Instillation of 0.25% riboflavin (VibeX Xtra, Avedro, Inc.) on the stromal bed following excimer laser ablation

Figure 2

Anterior segment optical coherence tomography demonstrating a well-apposed flap and the demarcation line in a case of femtosecond LASIK with half-fluence accelerated cross-linking

Figure 3

Anterior segment optical coherence tomography after placement of stromal lenticule and initial riboflavin soakage

Figure 4

Anterior segment optical coherence tomography demonstrates greater depth of demarcation line in the area of higher fluence delivery, with shallower demarcation line peripherally