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Abstract
Corneal collagen cross-linking (CXL) entails the use of ultraviolet light with a cross-linking agent to form cross bridges in the corneal collagen fibers with subsequent strengthening of the corneal stroma. CXL was first reported on humans in 2003 for patients with keratoconus. Since then, the procedure showed promising results in post-LASIK ectasia. One of the new applications of CXL is in infectious keratitis. In this review, the authors discuss the applications of CXL and cover the new advances in this field. CXL is still not US FDA approved in the USA.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.
No writing assistance was utilized in the production of this manuscript.
Key issues
Cross-linking (CXL), a procedure that uses UVA light in conjunction with riboflavin as a photomediator, creates new covalent cross-links between collagen fibrils, thus strengthening and stabilizing the cornea.
It has been shown not only to arrest progression of keratectasia in progressive keratoconus and post-LASIK corneas, but also to exert a moderately positive effect on visual status.
Infectious keratitis has also been reported to benefit from CXL. Except for Acanthamoeba keratitis, the use of CXL in treating keratitis is a promising method, especially in parts of the world where antibiotics are scarce or expensive.
Corneal edema is another application for CXL, although the benefits are temporary.
Further research directed at decreasing both the duration of the procedure as well as the need to remove the epithelium is a promising new frontier for CXL.