The theory and art of corneal cross-linking
Before the discovery of corneal cross-linking (CXL), patients with keratoconus would have had to undergo corneal transplantation, or wear rigid gas permeable lenses (RGPs) that would temporarily flatten the cone, thereby improving the vision. The RGP contact lens (CL) would not however alter the cor...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2013-01-01
|
| Series: | Indian Journal of Ophthalmology |
| Subjects: | |
| Online Access: | http://www.ijo.in/article.asp?issn=0301-4738;year=2013;volume=61;issue=8;spage=416;epage=419;aulast=McQuaid |
| _version_ | 1819228570311983104 |
|---|---|
| author | Rebecca McQuaid Arthur B Cummings Michael Mrochen |
| author_facet | Rebecca McQuaid Arthur B Cummings Michael Mrochen |
| author_sort | Rebecca McQuaid |
| collection | DOAJ |
| description | Before the discovery of corneal cross-linking (CXL), patients with keratoconus would have had to undergo corneal transplantation, or wear rigid gas permeable lenses (RGPs) that would temporarily flatten the cone, thereby improving the vision. The RGP contact lens (CL) would not however alter the corneal stability and if the keratoconus was progressive, the continued steepening of the cone would occur under the RGP CL. To date, the Siena Eye has been the largest study to investigate long term effects of standard CXL. Three hundred and sixty-three eyes were treated and monitored over 4 years, producing reliable long-term results proving long-term stability of the cornea by halting the progression of keratoconus, and proving the safety of the procedure. Traditionally, CXL requires epithelial removal prior to corneal soakage of a dextran-based 0.1% riboflavin solution, followed by exposure of ultraviolet-A (UV-A) light for 30 min with an intensity of 3 mW/cm2. A series of in vitro investigations on human and porcine corneas examined the best treatment parameters for standard CXL, such as riboflavin concentration, intensity, wavelength of UV-A light, and duration of treatment. Photochemically, CXL is achieved by the generation of chemical bonds within the corneal stroma through localized photopolymerization, strengthening the cornea whilst minimizing exposure to the surrounding structures of the eye. In vitro studies have shown that CXL has an effect on the biomechanical properties of the cornea, with an increased corneal rigidity of approximately 70%. This is a result of the creation of new chemical bonds within the stroma. |
| first_indexed | 2024-12-23T10:59:23Z |
| format | Article |
| id | doaj.art-0b75fe673c894892bafbefb01dce1f90 |
| institution | Directory Open Access Journal |
| issn | 0301-4738 1998-3689 |
| language | English |
| last_indexed | 2024-12-23T10:59:23Z |
| publishDate | 2013-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Ophthalmology |
| spelling | doaj.art-0b75fe673c894892bafbefb01dce1f902022-12-21T17:49:41ZengWolters Kluwer Medknow PublicationsIndian Journal of Ophthalmology0301-47381998-36892013-01-0161841641910.4103/0301-4738.116069The theory and art of corneal cross-linkingRebecca McQuaidArthur B CummingsMichael MrochenBefore the discovery of corneal cross-linking (CXL), patients with keratoconus would have had to undergo corneal transplantation, or wear rigid gas permeable lenses (RGPs) that would temporarily flatten the cone, thereby improving the vision. The RGP contact lens (CL) would not however alter the corneal stability and if the keratoconus was progressive, the continued steepening of the cone would occur under the RGP CL. To date, the Siena Eye has been the largest study to investigate long term effects of standard CXL. Three hundred and sixty-three eyes were treated and monitored over 4 years, producing reliable long-term results proving long-term stability of the cornea by halting the progression of keratoconus, and proving the safety of the procedure. Traditionally, CXL requires epithelial removal prior to corneal soakage of a dextran-based 0.1% riboflavin solution, followed by exposure of ultraviolet-A (UV-A) light for 30 min with an intensity of 3 mW/cm2. A series of in vitro investigations on human and porcine corneas examined the best treatment parameters for standard CXL, such as riboflavin concentration, intensity, wavelength of UV-A light, and duration of treatment. Photochemically, CXL is achieved by the generation of chemical bonds within the corneal stroma through localized photopolymerization, strengthening the cornea whilst minimizing exposure to the surrounding structures of the eye. In vitro studies have shown that CXL has an effect on the biomechanical properties of the cornea, with an increased corneal rigidity of approximately 70%. This is a result of the creation of new chemical bonds within the stroma.http://www.ijo.in/article.asp?issn=0301-4738;year=2013;volume=61;issue=8;spage=416;epage=419;aulast=McQuaidEpidemiologykeratoconusprevalenceDisease pathogenesisgenetic heterogeneitygenetics and genomicsgenome-wide association studygenomic locikeratoconuslinkage mappingmolecular mechanismswhole exome-genome sequencingDeregulationectasiagene expressionkeratoconusmass spectroscopyproteomicssignaling pathwaysCorneacrosslinkingkeratoconusmodulusCorneal topographyimagingkeratoconusoptical coherence tomographyplacido disc based topographyEctatic diseasekeratoconusscheimpflug imagingKeratoconusocular allergyvernal keratoconjunctivitisContact lenskeratoconuspiggy back contact lensesrigid gas permeablescleral lensSynergEyestoric soft contact lensCorneal cross-linking techniquesnew technologiesriboflavin |
| spellingShingle | Rebecca McQuaid Arthur B Cummings Michael Mrochen The theory and art of corneal cross-linking Indian Journal of Ophthalmology Epidemiology keratoconus prevalence Disease pathogenesis genetic heterogeneity genetics and genomics genome-wide association study genomic loci keratoconus linkage mapping molecular mechanisms whole exome-genome sequencing Deregulation ectasia gene expression keratoconus mass spectroscopy proteomics signaling pathways Cornea crosslinking keratoconus modulus Corneal topography imaging keratoconus optical coherence tomography placido disc based topography Ectatic disease keratoconus scheimpflug imaging Keratoconus ocular allergy vernal keratoconjunctivitis Contact lens keratoconus piggy back contact lenses rigid gas permeable scleral lens SynergEyes toric soft contact lens Corneal cross-linking techniques new technologies riboflavin |
| title | The theory and art of corneal cross-linking |
| title_full | The theory and art of corneal cross-linking |
| title_fullStr | The theory and art of corneal cross-linking |
| title_full_unstemmed | The theory and art of corneal cross-linking |
| title_short | The theory and art of corneal cross-linking |
| title_sort | theory and art of corneal cross linking |
| topic | Epidemiology keratoconus prevalence Disease pathogenesis genetic heterogeneity genetics and genomics genome-wide association study genomic loci keratoconus linkage mapping molecular mechanisms whole exome-genome sequencing Deregulation ectasia gene expression keratoconus mass spectroscopy proteomics signaling pathways Cornea crosslinking keratoconus modulus Corneal topography imaging keratoconus optical coherence tomography placido disc based topography Ectatic disease keratoconus scheimpflug imaging Keratoconus ocular allergy vernal keratoconjunctivitis Contact lens keratoconus piggy back contact lenses rigid gas permeable scleral lens SynergEyes toric soft contact lens Corneal cross-linking techniques new technologies riboflavin |
| url | http://www.ijo.in/article.asp?issn=0301-4738;year=2013;volume=61;issue=8;spage=416;epage=419;aulast=McQuaid |
| work_keys_str_mv | AT rebeccamcquaid thetheoryandartofcornealcrosslinking AT arthurbcummings thetheoryandartofcornealcrosslinking AT michaelmrochen thetheoryandartofcornealcrosslinking AT rebeccamcquaid theoryandartofcornealcrosslinking AT arthurbcummings theoryandartofcornealcrosslinking AT michaelmrochen theoryandartofcornealcrosslinking |