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Review
. 2019 Jan;67(1):8-15.
doi: 10.4103/ijo.IJO_1403_18.

Current concepts in crosslinking thin corneas

Rashmi Deshmukh  1 , Farhad Hafezi  2 , George D Kymionis  3 , Sabine Kling  4 , Rupal Shah  5 , Prema Padmanabhan  6 , Mahipal S Sachdev  1
Affiliations
Review

Current concepts in crosslinking thin corneas

Rashmi Deshmukh et al. Indian J Ophthalmol. 2019 Jan.

Abstract

Corneal cross-linking (CXL), introduced by Wollensak et al. in 2003, is a minimally invasive procedure to halt the progression of keratoconus. Conventional CXL is recommended in eyes with corneal thickness of at least 400 microns after de-epithelialization to prevent endothelial toxicity. However, most of the keratoconic corneas requiring CXL may not fulfill this preoperative inclusion criterion. Moderate-to-advanced cases are often found to have a pachymetry less than this threshold. There are various modifications to the conventional method to circumvent this issue of CXL thin corneas while avoiding the possible complications. This review is an update on the modifications of conventional CXL for thin corneas.

Keywords: Cross-linking; keratoconus; thin cornea.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Collagen cross-linking using hypo-osmolar riboflavin. (a) Hypo-osmolar riboflavin instilled on the thin cornea. (b) Increased corneal pachymetry. (c) UVA radiation exposure given to the swollen cornea
Figure 2
Figure 2
Transepithelial collagen cross-linking. (a) Thin cornea soaked with riboflavin with penetration enhancers. (b) Epithelial loosening (blue-dotted line) and riboflavin penetration into the corneal stroma. (c) UVA radiation exposure given
Figure 3
Figure 3
Iontophoresis-assisted transepithelial collagen cross-linking. (a) Process of iontophoresis – delivery electrode placed on riboflavin-soaked cornea and counter electrode placed on forehead/cervical vertebrae of the patient. (b) 1 mA of current causes riboflavin penetration into corneal stroma
Figure 4
Figure 4
Lenticule-assisted Crosslinking. (a) Stromal lenticule removed during SMILE procedure. (b) Lenticule placed over de-epithelialized cornea and soaked with riboflavin drops. (c) UVA radiation given after confirming riboflavin penetration
Figure 5
Figure 5
Contact lens-assisted Crosslinking contact lens soaked in riboflavin solution placed over thin cornea and UVA radiation given
See this image and copyright information in PMC

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