{"id":127,"date":"2013-11-07T14:53:52","date_gmt":"2013-11-07T14:53:52","guid":{"rendered":"http:\/\/sites.cardiff.ac.uk\/ukcxl\/?page_id=127"},"modified":"2021-12-21T13:49:46","modified_gmt":"2021-12-21T13:49:46","slug":"accelerated-cross-linking","status":"publish","type":"page","link":"http:\/\/sites.cardiff.ac.uk\/ukcxl\/accelerated-cross-linking\/","title":{"rendered":"ACCELERATED CROSS-LINKING"},"content":{"rendered":"<p style=\"text-align: justify\">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 cross-linking procedure. In the standard cross-linking (SCXL) procedure 3 mWcm<sup>-2<\/sup> is applied to the central 9mm of the cornea for 30 minutes, resulting in a total energy dose of 3.4 J or a radiant exposure of 5.4 Jcm<sup>-2<\/sup>. However, this same level of radiant exposure can be achieved by applying a higher intensity for a shorter time.\u00a0 Laboratory studies on pig corneas showed that increasing the illuminance intensity to 9 mWcm<sup>-2<\/sup> and reducing the exposure time to 10 minutes for an accelerated cross-linking (ACXL) procedure produced a similar increase in corneal stiffness and resistance to enzymatic digestion to that gained using the standard procedure <strong>[1-2] <\/strong>.\u00a0 The safety of using higher intensities (up to 30 mWcm<sup>-2<\/sup><i>) in vivo<\/i> has produced varying results. Konstantopoulos and Mehta <strong>[3]<\/strong> compared three protocols of CXL, and concluded that ACXL using 9 mW\/cm<sup>2<\/sup>\u00a0for 10 minutes and 7 mW\/cm<sup>2<\/sup> for 15 minutes may be as efficacious as SCXL.\u00a0 However, Shetty et al.<strong> [4]<\/strong> reported that at 6-months follow-up the flattening effect was better in patients treated with SCXL compared to those treated using ACXL protocols of 9 mW\/cm<sup>2<\/sup>\u00a0for 10 minutes, 18 mW\/cm<sup>2<\/sup>\u00a0for 5 minutes, and 30 mW\/cm<sup>2<\/sup> for 3 minutes. A meta-analysis of eleven clinical trials has revealed that overall, SCXL appears to have a greater effect than ACXL in terms of stabalising corneal topography but ACXL results in less reduction in corneal thickness <strong>[5]<\/strong>.<\/p>\n<p style=\"text-align: justify\"><strong>[1]<\/strong> Schumacher, S. et al. Equivalence of biomechanical changes induced by rapid and standard corneal cross-linking, using riboflavin and ultraviolet radiation. <em><span class=\"journal-name\">Investigative Ophthalmology &amp; Visual Science<\/span><\/em> 2011; 52: 9048\u20139052.<\/p>\n<p><strong>[2]<\/strong> Aldahlawi NH, et al. Standard versus accelerated riboflavin-ultraviolet collagen crosslinking: resistance against enzymatic digestion. <em><span class=\"journal-name\">Investigative Ophthalmology &amp; Visual Science <\/span><\/em>2015; 41:1989-96.<\/p>\n<p><strong>[3]<\/strong> Konstantopoulos A, Mehta JS. Conventional versus accelerated collagen cross-linking for keratoconus.\u00a0<em>Eye Contact Lens<\/em>. 2015; 41: 65\u201371.<\/p>\n<p><strong>[4]<\/strong> Shetty R, Nagaraja H, Jayadev C, et al. Accelerated corneal collagen cross-linking in pediatric patients: two-year follow-up results.\u00a0<em>Biomed Res Int<\/em>. 2014; 2014: 894095.<\/p>\n<p><strong>[5]<\/strong> Wen D., et al. Comparison of Standard Versus Accelerated Corneal Collagen Cross-Linking for Keratoconus: A Meta-Analysis.<em> <span class=\"journal-name\">Investigative Ophthalmology &amp; Visual Science<\/span><\/em> 2018, 59: 3920-3931<\/p>\n<h1><\/h1>\n<p>Last updated: April 2020<\/p>\n","protected":false},"excerpt":{"rendered":"<p>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 cross-linking procedure. In the standard cross-linking (SCXL) procedure 3 mWcm-2 is applied to the central 9mm of the cornea for 30 minutes, resulting in a total energy dose of 3.4 [&hellip;]<\/p>\n","protected":false},"author":826,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-127","page","type-page","status-publish","hentry"],"jetpack_shortlink":"https:\/\/wp.me\/P3RmFt-23","jetpack_sharing_enabled":true,"meta_box":[],"_links":{"self":[{"href":"http:\/\/sites.cardiff.ac.uk\/ukcxl\/wp-json\/wp\/v2\/pages\/127","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/sites.cardiff.ac.uk\/ukcxl\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/sites.cardiff.ac.uk\/ukcxl\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/sites.cardiff.ac.uk\/ukcxl\/wp-json\/wp\/v2\/users\/826"}],"replies":[{"embeddable":true,"href":"http:\/\/sites.cardiff.ac.uk\/ukcxl\/wp-json\/wp\/v2\/comments?post=127"}],"version-history":[{"count":9,"href":"http:\/\/sites.cardiff.ac.uk\/ukcxl\/wp-json\/wp\/v2\/pages\/127\/revisions"}],"predecessor-version":[{"id":1697,"href":"http:\/\/sites.cardiff.ac.uk\/ukcxl\/wp-json\/wp\/v2\/pages\/127\/revisions\/1697"}],"wp:attachment":[{"href":"http:\/\/sites.cardiff.ac.uk\/ukcxl\/wp-json\/wp\/v2\/media?parent=127"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}