Rose bengal/green light corneal cross-linking (RGX) is a relatively new development in cross-linking technology. The technique uses green light to activate rose bengal, a well-known diagnostic agent for ocular surface damage, and increase the stiffness of the tissue and its resistance to enzymatic digestion [1,2]. This technology has already proved useful in ocular therapy for sealing corneal lacerations [3-5], bonding amniotic membrane to the cornea , attaching IOL haptics to the capsular bag , treating Acanthamoeba Trophozoites and cysts , and it has been successfully used in many other tissues . In contrast to riboflavin/UVA cross-linking, which causes apoptotic cell death at depths of up to 350 µm, the RGX cross-linking effect is limited to the anterior 100 µm of the tissue and is non-toxic to stromal keratocytes [10,11]. Air puff deformation imaging of rabbit eyes indicate that the overall corneal stiffening effect achieved with RGX does not match that of riboflavin/UVA cross-linking . However, reconstructed bio-mechanical parameters from numerical finite element simulations show that the cross-linked layer of the cornea is actually stiffer after RGX than after riboflavin/UVA cross-linking . Recent studies have shown that iontophoresis may be an effective means of helping rose bengal diffuse deeper into the cornea to increase the depth of RGX cross-linking .
Although further research is warranted, current evidence suggests that RGX may be a promising candidate for the treatment of very thin corneas.
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 Bekesi N, Gallego-Munoz P, Ibares-Frias L, et al. Biomechanical Changes After In Vivo Collagen Cross-Linking With Rose Bengal-Green Light and Riboflavin-UVA. Invest Ophthalmol Vis Sci. (2017). 58: 1612-1620.
 Tefon Aribas AB, Sarikaya B, Bilgihan K. Iontophoresis-Assisted Rose Bengal and Green Light Corneal Cross-Linking. Cornea. (2020). 39:1533-1540.
Last updated: April 2021