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Corneal Crosslinking for Keratoconus and Corneal Ectasia

  • Peter S. HershEmail author
  • Steven A. Greenstein
Chapter

Abstract

Corneal collagen crosslinking (CXL) is a treatment designed to decrease the progression of keratoconus, in particular, and other corneal thinning processes such as post-LASIK and PRK ectasia. CXL may have beneficial vision and optical effects as well. In the CXL procedure, riboflavin (Vitamin B2) is administered in conjunction with ultraviolet A (UVA – 370 nm) producing a photochemical reaction in the corneal stroma with consequent mechanical stiffening of the cornea. Studies suggest that crosslinking is effective in decreasing progression of keratoconus and corneal ectasias. Maximum keratometry generally flattens by 1D to 3D 1 year after CXL. Similarly, corneal topography indices, higher-order aberrations, and subjective visual function generally improve after CXL. In addition, best-corrected visual acuity improves by about 1 Snellen line, on average. After crosslinking, clinical outcomes appear to worsen at 1 month and improve between 3 and 12 months. During the wound healing course, there is a typical crosslinking-associated corneal haze, which peaks at 1 month, and improves between 3 and 12 months, postoperatively. From the viewpoint of clinical decision-making, it is reasonable to consider all eyes with progressive keratoconus or corneal ectasia for crosslinking; however, eyes with good visual acuity (better than 20/40) may be somewhat more susceptible to a loss of 1 Snellen line of acuity after CXL. New clinical studies are underway to investigate transepithelial, accelerated, and customized crosslinking procedures as well as crosslinking as an adjunctive treatment with other procedures such as intracorneal ring segments and PRK.

Keywords

Corneal collagen crosslinking Keratoconus Post-Lasik and PRK ectasia Maximum keratometry Crosslinking-associated corneal haze Riboflavin Ultraviolet light Intracorneal ring segments Photorefractive keratectomy 

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Cornea and Laser Eye Institute-Hersh Vision Group, CLEI Center for Keratoconus, Teaneck, NJ, Department of Ophthalmology, Rutgers - NJ Medical SchoolNewarkUSA

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