Journal of Ophthalmology
Volume 2015 (2015), Article ID 302983, 2 pages
http://dx.doi.org/10.1155/2015/302983

Editorial

Current Concepts and Future Developments of Corneal Cross-Linking

Suphi Taneri,¹ Elias Jarade,² John A. Kanellopoulos,3,4 and David Muller⁵

¹Center for Refractive Surgery, Eye Department, St. Francis Hospital, 48145 Münster, Germany
²Cornea and Refractive Surgery Department, International Medical Center, Dubai, UAE
³LaserVision Eye Institute, Athens, Greece
⁴New York University School of Medicine, New York, NY, USA
⁵Avedro, Inc., Waltham, MA, USA

Received 14 December 2014; Accepted 14 December 2014

Copyright © 2015 Suphi Taneri et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The introduction of corneal cross-linking (CXL) has changed the landscape of treatment and management of keratoconus and ectasia after refractive surgery. Previously, treatment options provided only temporary visual rehabilitation without limiting disease progression. Keratoconus and ectasia resulted in significant vision-related reduction in quality of life and a substantial lifetime economic burden, with up to 20% of keratoconus cases resulting in eventual corneal transplantation [1]. CXL was introduced as the first therapeutic option for keratoconus aimed at stiffening the cornea in order to treat the underlying stromal instability. From the time that the first reports of the clinical application of cross-linking in the cornea were published in 2003 [2], CXL has rapidly been adopted as a standard therapy for treatment of progressive keratoconus in much of the world [3–5].

The potential for early intervention with corneal cross-linking before visual function has been compromised has resulted in a shift in the way we think about corneal biomechanics and has reawakened interest in the early diagnosis of ectasia. In this issue, J. Steinberg et al. report two new parameters to detect biomechanical changes in the keratoconic cornea after CXL using in vivo corneal visualization Scheimpflug technology. Research in the area of corneal biomechanics has the potential to enable earlier diagnosis of patients in need of CXL and better analysis of the effects of the procedure.

While many questions remain unanswered, the understanding of the photochemical mechanisms that result in the formation of cross-links in the cornea has grown exponentially in the last decade. Improved scientific understanding of the mechanisms of CXL has driven clinical research aimed at optimizing CXL for better efficiency and efficacy [6]. In this issue, A. C. da Paz et al. present a critical review of known and as yet undetermined effects of CXL on corneal structure, biomechanics, and functional aspects. J. Antoun et al. examine patient characteristics that contribute to cross-linking failure to stabilize keratometry and examine the effect of repeat treatments on eyes that have continued to progress after primary CXL.

The remaining contributions to the special issue explore modifications to the conventional protocol that incorporate new technology, such as transepithelial riboflavin formulations designed to improve patient comfort (S. Taneri et al.) and higher irradiance and pulsed UVA delivery aimed at improving procedure speed and photon efficiency (C. Mazzotta et al.). CXL combination procedures targeted at maximizing visual outcomes through the addition of simultaneous intracorneal ring implantation (P. Studeny et al.) or subsequent phakic toric implantable collamer lens insertion (R. Antonios et al.) are also discussed.

Together, the papers in this special issue describe the next generation of corneal cross-linking. The contributors explore the potential to maximize CXL efficacy, provide equivalent or greater treatment effect in shorter total treatment times, reduce patient discomfort and speed visual recovery, and offer both stabilization and functional visual improvement through CXL combination procedures.

Suphi Taneri
Elias Jarade
John A. Kanellopoulos
David Muller

References

R. L. Rebenitsch, S. M. Kymes, J. J. Walline, and M. O. Gordon, “The lifetime economic burden of keratoconus: a decision analysis using a markov model,” American Journal of Ophthalmology, vol. 151, no. 5, pp. 768–773, 2011.

G. Wollensak, E. Spoerl, and T. Seiler, “Riboflavin/ultraviolet-A-induced collagen crosslinking for the treatment of keratoconus,” American Journal of Ophthalmology, vol. 135, no. 5, pp. 620–627, 2003.

E. Chan and G. R. Snibson, “Current status of corneal collagen cross-linking for keratoconus: a review,” Clinical and Experimental Optometry, vol. 96, no. 2, pp. 155–164, 2013.

P. T. Ashwin and P. J. McDonnell, “Collagen cross-linkage: a comprehensive review and directions for future research,” British Journal of Ophthalmology, vol. 94, no. 8, pp. 965–970, 2010.

K. M. Meek and S. Hayes, “Corneal cross-linking—a review,” Ophthalmic and Physiological Optics, vol. 33, no. 2, pp. 78–93, 2013.

G. Lytle, “Advances in the technology of corneal cross-linking for keratoconus,” Eye & Contact Lens, vol. 40, no. 6, pp. 358–364, 2014.