Ultraviolet A/Riboflavin Corneal Cross-linking for Infectious Keratitis Associated With Corneal Melts

Iseli, Hans Peter; Thiel, Michael; Hafezi, Farhad; Kampmeier, Juergen; Seiler, Theo

doi:10.1097/ico.0b013e318169d698

Cited by 290 publications

(235 citation statements)

References 18 publications

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“…Furthermore, UV radiation itself can damage both DNA and RNA of pathogens and is used as an antimicrobial procedure 22. 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.…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

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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“…Studies show that therapeutic transplants represent 2.6% to 17.9% of total penetrating transplants (17) . There are reports of corneal ulcers treated successfully with corneal collagen crosslinking (CXL) (18)(19)(20)(21)(22)(23)(24)(25) . An experimental study found increased resistance to enzymatic digestion by collagenase, pepsin, and trypsin in corneas subjected to CXL (26) .…”

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confidence: 99%

Efeito terapêutico do crosslinking corneal na ceratite infecciosa

Escarião¹,

Ribeiro²,

Jorge³

et al. 2013

Rev. bras.oftalmol.

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Purpose:To evaluate the effect of corneal crosslinking (CXL) RESUMOObjetivo: Avaliar o efeito do crosslinking (CXL) no tratamento de ceratite infecciosa, resistente ao tratamento clínico, e investigar a relação com o agente etiológico. Métodos: Foram incluídos 11 pacientes com diagnóstico de ceratite infecciosa de etiologia bacteriana (sete olhos) e fúngica (quatro olhos) na Fundação Altino Ventura (FAV) no período de outubro de 2011 a maio de 2012. Os pacientes incluídos estavam em uso de colírios há pelo menos sete dias e não apresentavam melhora da infecção. Estes foram avaliados antes da realização do CXL e no período pós-operatório até cicatrização da úlcera. Para realização do CXL foram instiladas gotas de riboflavina a 0,1% e dextrano a 20%, a cada cinco minutos em um período de 30 minutos antes do procedimento, e durante a aplicação da luz ultravioleta A (UVA). A córnea foi exposta à UVA com comprimento de onda de 370ηm ± 5ηm e uma irradiância de 3mW/cm². Resultados: Os pacientes com infecção bacteriana obtiveram cura do processo infeccioso após o CXL e nenhum paciente com ceratite fúngica apresentou cicatrização. Observou-se associação significante (p = 0,003) entre o agente etiológico e a cicatrização. Conclusão: O CXL mostrou-se eficaz no tratamento da ceratite bacteriana resistente ao tratamento clínico, evitando a realização de transplante tectônico. Em relação à ceratite fúngica, este procedimento não influenciou na melhora do processo infeccioso.Descritores: Córnea; Reagentes para ligações cruzadas/uso terapêutico; Ceratite infecciosa/quimioterapia; Ceratite bacteriana/ quimioterapia; Ceratite fúngica/quimioterapia

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“…Riboflavin and ultraviolet-A (UVA)-induced crosslinking of corneal collagen (CXL) is a method to increase the biomechanical [1][2][3][4] and biochemical 5,6 stability of the cornea by inducing additional crosslinks within or between collagen fibers using UVA light and the photomediator riboflavin. The therapeutic potential of CXL to treat progressive keratoconus was demonstrated in a clinical pilot study, 3 as well as in controlled prospective studies and in case reports and case series of patients with iatrogenic keratectasia after refractive laser surgery.…”

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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Ultraviolet A/Riboflavin Corneal Cross-linking for Infectious Keratitis Associated With Corneal Melts

Cited by 290 publications

References 18 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

Efeito terapêutico do crosslinking corneal na ceratite infecciosa

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

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