Keratoconus and crosslinking: pharmacokinetic considerations

Area of Science:

• Ophthalmology
• Corneal Ectasias
• Biochemistry

Background:

• Keratoconus (KC) is an ectatic disorder causing progressive corneal thinning and scarring.
• The exact etiology of KC remains largely unknown, leading to irregular astigmatism, myopia, and visual impairment.

Purpose of the Study:

• Review biochemical factors in KC pathogenesis.
• Discuss the role of inflammation in KC.
• Evaluate emerging corneal collagen crosslinking (CCL) protocols and their cellular toxicities.

Main Methods:

• Literature review of biochemical factors in KC.
• Analysis of inflammation's role in KC pathogenesis.
• Discussion of novel CCL protocols (hypoosmolar riboflavin, transepithelial) and associated cellular toxicities.

Main Results:

• Emerging evidence suggests inflammation plays a role in KC pathogenesis.
• New CCL protocols are being developed with varying cellular toxicities.
• Long-term outcomes of standard and novel CCL protocols are under investigation.

Conclusions:

• Pharmacokinetic considerations and potential toxicities of CCL protocols are crucial.
• Combining CCL with intrastromal corneal ring segments or photorefractive keratectomy can enhance visual rehabilitation.
• Further research, including randomized controlled trials, is needed to explore CCL's efficacy beyond halting disease progression and identify new indications.