Treatment with BAC 0.02% induces sufficient epithelial permeability for the passage of riboflavin, which enables its stromal diffusion and results in increased corneal stiffening after cross-linking as compared to the standard protocol. Further safety studies will be required before clinical use.

K-values and corneal thickness could be considered as predictive factors for the possible development of corneal scarring after riboflavin-UVA-induced CXL. Advanced keratoconus appears to be associated with a higher risk of corneal scar development due to lower corneal thickness, greater curvature and intrinsic tissue characteristics.

The results of this study using hypo-osmolar riboflavin solution in a cross-linking procedure for thin corneas showed a stability of keratoconus 1 year after CXL. Application of the hypo-osmolar riboflavin solution prevented cross-linked corneas from developing stromal scars.

We report the case of a 42-year-old patient who presented with unilateral loss of vision in the left eye. The clinical examination revealed retinal detachment and a low intraocular pressure was found in the left eye. Except for an extinct electroretinogram (ERG) and a siderosis bulbi in the left eye no signs of an intraocular body were detectable, either in the ultrasound B-scan or in the clinical examination. Pars plana vitrectomy with silicon oil tamponade was performed and revealed an iron-containing body next to the fovea which was removed without any complications. Despite an initially easily visible retinal detachment, a newly acquired siderosis bulbi in combination with ocular trauma in the clinical history should raise the suspicion of a residual intraocular iron foreign body, until this can be disproven.

In accordance with the induced higher-order aberrations both surgical techniques can be considered as being equivalent.