RIBOFLAVIN/UVA CROSS-LINKING

HISTORICAL BACKGROUND

The potential of ultraviolet-A light (UVA) to cross-link tissues in the presence of the non-toxic photosensitising agent riboflavin had been known for some time, but it was not until 1998 that a group from Dresden suggested it as a potential therapeutic treatment to strengthen the corneal stroma….Read more

MECHANISM OF CROSS-LINKING

At present, it is still not known exactly what the nature of the cross-links is, and precisely where they occur within the extracellular matrix. Theoretically cross-linking could occur not just between collagen molecules but also between collagens and proteoglycan core proteins….Read more

DRESDEN PROTOCOL

CXL procedure

The original cross-linking procedure (commonly referred to as the ‘Dresden protocol’) involved anaesthetising the eye (for example with proxymetacainhydrochloride 0.5% drops), removing the central 8-10mm of the epithelium and applying a riboflavin solution….Read more

TRANS-EPITHELIAL PROCEDURES

In order to overcome the problems of postoperative discomfort, potential for delayed epithelial healing, infection, stromal haze, and corneal melting sometimes associated with the standard cross-linking procedure, researchers are investigating modifications to the procedure which will allow the same stiffening effect to occur in the corneal stroma without the need for epithelial removal….Read more

ACCELERATED CROSS-LINKING

With the aim of reducing treatment time and increasing the throughput of patients, investigators are now considering the use of higher illumination intensities in the CXL procedure….Read more

MODIFIED PROTOCOL FOR THE TREATMENT OF THIN CORNEAS

Overcoming the contra-indication of treating corneas with a thickness bordering on 400μm….Read more