Safety of UVA-Riboflavin Cross-Linking of the Cornea

Spoerl, Eberhard; Mrochen, Michael; Sliney, David H.; Trokel, Stephen L.; Seiler, Theo

doi:10.1097/ico.0b013e3180334f78

Cited by 735 publications

(587 citation statements)

References 26 publications

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“…Consistent with previous studies,26, 27, 28 our CXL procedure reduced corneal keratocyte numbers in the stroma. After the topical application of the riboflavin solution and UVA irradiation, in addition to the biomechanical stiffening effect of the procedure, the reaction of riboflavin and UVA leads to the release of highly reactive singlet oxygen and other reactive oxygen radicals, which can cause apoptosis of keratocytes and endothelial cells in the cornea 26, 27, 28.…”

Section: Discussionsupporting

confidence: 92%

“…After the topical application of the riboflavin solution and UVA irradiation, in addition to the biomechanical stiffening effect of the procedure, the reaction of riboflavin and UVA leads to the release of highly reactive singlet oxygen and other reactive oxygen radicals, which can cause apoptosis of keratocytes and endothelial cells in the cornea 26, 27, 28. Because corneal BVs and LVs mainly grow in the upper corneal stromal layer, the reaction of riboflavin and UVA should also induce similar apoptosis of endothelial cells in corneal vessels and thereafter lead to the regression.…”

Section: Discussionmentioning

confidence: 99%

“…After riboflavin application, UVA absorption in the stroma increases to 95% 27, 39. The reason for the high absorption rate is that the wavelength range of UVA llight (315‐400 nm) corresponds to one of the riboflavin absorption maxima (ie, 370 nm) 26. Because of the high absorption, the UVA irradiation dose that reaches the lens and retina is very small (0.22‐0.32 mJ/cm 2 ), which may be comparable to the outdoor exposure to UVA sunlight for a day 40.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, CXL with the interaction of riboflavin and UV irradiation was reported to also be used in corneal infections 23, 24, 25. After the topical application of riboflavin and UVA light, the reaction causes the release of very reactive singlet oxygen and other reactive oxygen radicals, which leads to apoptosis of, for example, keratocytes in the cornea 26, 27, 28. It has been shown that CXL can lead to a reduction in corneal keratocytes 29.…”

Section: Introductionmentioning

confidence: 99%

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UV light crosslinking regresses mature corneal blood and lymphatic vessels and promotes subsequent high-risk corneal transplant survival

Hou

Tóth

et al. 2018

American Journal of Transplantation

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Immunologic graft rejection is the main complication after corneal transplant into pathologically prevascularized so‐called high‐risk eyes. The aim of this study was to evaluate whether ultraviolet (UV) light crosslinking can regress pathologic corneal blood and lymphatic vessels and thereby improve subsequent graft survival. Using the murine model of suture‐induced corneal neovascularization, we found that corneal crosslinking with UVA light and riboflavin regressed both preexisting blood and lymphatic vessels significantly via induction of apoptosis in vascular endothelial cells. In addition, macrophages and CD45+ cell counts were significantly reduced. Consistently, corneal crosslinking reduced keratocyte density and corneal thickness without affecting corneal nonvascular endothelial cells, iris, and lens depending on the crosslinking duration. Furthermore, using the murine model of corneal transplant, long‐term graft survival was significantly promoted (P < .05) and CD4+ CD25+FoxP3+ T regulatory cells were upregulated (P < .01) in high‐risk eyes preoperatively treated with crosslinking. Our results suggest UV light crosslinking as a novel method to regress both pathologic corneal blood and lymphatic vessels and to reduce CD45+ inflammatory cells. Furthermore, this study demonstrates for the first time that preoperative corneal crosslinking in prevascularized high‐risk eyes can significantly improve subsequent graft survival and may become a promising novel therapy in the clinic.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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UV light crosslinking regresses mature corneal blood and lymphatic vessels and promotes subsequent high-risk corneal transplant survival

Hou

Tóth

et al. 2018

American Journal of Transplantation

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“…[2][3][4][11][12][13][14] To protect the corneal endothelium and deeper ocular structures, the currently used treatment parameters are set so the anterior 250 to 350 mm of corneal stroma are treated. 15 Accordingly, the current inclusion criteria require a minimum stromal thickness (without the corneal epithelium) of 400 mm, including a safety margin.…”

mentioning

confidence: 99%

Collagen crosslinking with ultraviolet-A and hypoosmolar riboflavin solution in thin corneas

Hafezi¹,

Mrochen²,

Iseli³

et al. 2009

Journal of Cataract and Refractive Surgery

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314

230

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Corneal collagen crosslinking (CXL) with riboflavin and ultraviolet-A light is a method for treating progressive keratectasia. The currently accepted treatment parameters induce collagen crosslinking in the anterior 250 to 350 mm of corneal stroma. To protect the endothelium, CXL inclusion criteria require a minimum corneal thickness of 400 mm after removal of the epithelium. In advanced keratoconus, however, progressive corneal thinning often leads to a remaining stromal thickness of less than 400 mm. We have therefore modified the current treatment protocol by preoperatively swelling thin corneas to a stromal thickness of at least 400 mm using hypoosmolar riboflavin solution. This treatment protocol was performed in a case series of 20 patients, and no complications were observed. Preoperative swelling of the cornea safely broadens the spectrum of CXL indications to thin corneas that would otherwise not be eligible for treatment.

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Intraoperative and Postoperative Effects of Corneal Collagen Cross-linking on Progressive Keratoconus

Vinciguerra¹

2009

Arch Ophthalmol

182

115

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To report intraoperative and 24-month refractive, topographic, tomographic, and aberrometric outcomes after corneal collagen cross-linking in progressive advanced keratoconus. Methods: Prospective, nonrandomized single-center clinical study involving 28 eyes. Main outcome measures included uncorrected and best spectaclecorrected visual acuities, sphere and cylinder refraction, topography, tomography, aberrometry, and endothelial cell count evaluated at baseline and follow-up at 1, 3, 6, 12, and 24 months after treatment. Topography was also recorded intraoperatively. Results: Two years after treatment, mean baseline uncorrected and best spectacle-corrected visual acuities improved significantly (P=.048 and Ͻ.001, respectively) and mean spherical equivalent refraction decreased significantly (P=.03). Mean baseline flattest and steepest me

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Safety of UVA-Riboflavin Cross-Linking of the Cornea

Cited by 735 publications

References 26 publications

UV light crosslinking regresses mature corneal blood and lymphatic vessels and promotes subsequent high-risk corneal transplant survival

UV light crosslinking regresses mature corneal blood and lymphatic vessels and promotes subsequent high-risk corneal transplant survival

Collagen crosslinking with ultraviolet-A and hypoosmolar riboflavin solution in thin corneas

Intraoperative and Postoperative Effects of Corneal Collagen Cross-linking on Progressive Keratoconus

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