Corneal Crosslinking in Refractive Corrections

Abstract

Corneal crosslinking has been well-described for the treatment of progressive corneal ectasias. Although the goal of treatment in these conditions is the decrease in the risk of progressive steepening of the cornea, studies have shown that flattening of the cornea is achieved in many cases. This finding has led to the postulation that corneal crosslinking may have a potential role in the primary treatment of myopia, and that targeted approaches with more specialized patterns of treatment may be used as primary treatments for astigmatism and hyperopia. In this review, we provide a summary of the clinical and laboratory-based studies evaluating corneal crosslinking as a primary, solitary, refractive treatment for myopia, hyperopia, and astigmatism. Clinical studies thus far are small case series. The primary benefit of refractive corneal crosslinking seems to be the correction of small myopic or hyperopic refractive errors without the need for corneal incisions or tissue removal. Translational Relevance The clinical application of corneal crosslinking relies on a good understanding of the biomechanical effect of various treatment parameters on corneal tissue. We discuss the results of the clinical and laboratory studies evaluating corneal crosslinking as a primary refractive treatment.

Corneal Collagen Crosslinking for Ectasia After Refractive Surgery: A Systematic Review and Meta-Analysis

“…However, its effect on hypermetropia remains a subject of ongoing debate. 53 Furthermore, the heterogeneity was low, unlike in other studies that compared SE with CXL treatment. 25 Analysis of the topographic results further supports the positive impact of CXL on corneal anatomy.…”

Biomechanical Evaluation of Decellularized and Crosslinked Corneal Implants Manufactured From Porcine Corneas as a Treatment Option for Advanced Keratoconus

“…Furthermore, as the implants are formed from material derived from biological tissue, a greater understanding of the potential variability of biomechanical properties across implants is required, in addition to a better understanding of the individual biomechanics of the system into which it is inserted. Pilot studies of CXL for both keratoconus ( O'Brart et al, 2015 ) and myopia ( Juthani and Chuck, 2021 ) have shown that there is variability between patients with regards to their response to crosslinking treatments, hence the same is likely to be true of the porcine tissue from which the lenticules are formed. With a better understanding of these factors, it may be possible to accurately control the biomechanical properties of individual implants and in doing so manufacture implants with customised properties for an individual’s cornea, or to quantify and standardise the properties of implants used in surgery.…”

Two‐photon collagen crosslinking in ex vivo human corneal lenticules induced by near‐infrared femtosecond laser

“…diseases related to collagen-rich tissues [7][8][9][10][11][12]. In past decades, tremendous efforts have been devoted to correct myopia and keratoconus by riboflavin (RF)/ultraviolet A (UVA) light-based CXL [8,[13][14][15][16][17][18][19]. During this procedure, corneal stroma is soaked with photosensitizer RF and subsequently irradiated by UVA light.…”

“…Laser‐induced crosslinking (CXL) has been demonstrated as an effective approach altering the refractive power and mechanical properties (increasing its rigidity) of the cornea, open new opportunities for the treatment of both myopia and keratoconus, and have a promising prospect in treating diseases related to collagen‐rich tissues [7–12]. In past decades, tremendous efforts have been devoted to correct myopia and keratoconus by riboflavin (RF)/ultraviolet A (UVA) light‐based CXL [8, 13–19]. During this procedure, corneal stroma is soaked with photosensitizer RF and subsequently irradiated by UVA light.…”