Current perspectives on corneal collagen crosslinking (CXL)

Area of Science:

• Ophthalmology
• Corneal Surgery
• Biomaterials Science

Background:

• Corneal collagen crosslinking (CXL) has become a cornerstone in managing progressive keratoconus and post-refractive ectasia.
• The conventional Dresden Protocol (C-CXL) involves epithelial removal to enhance riboflavin penetration and UV-A irradiation for stromal stiffening.

Purpose of the Study:

• To review and analyze current clinical and laboratory findings on various CXL protocols for keratoconus treatment.
• To compare the efficacy and safety of modified CXL techniques against the conventional method.

Main Methods:

• Systematic review of existing literature on conventional, accelerated, and transepithelial corneal crosslinking.
• Analysis of clinical outcomes, including visual acuity, topographical changes, and patient comfort.
• Evaluation of laboratory findings related to biomechanical and cellular effects of different CXL protocols.

Main Results:

• Conventional CXL (C-CXL) demonstrates prevailing advantages despite some outcome inconsistencies.
• Modified techniques like accelerated and transepithelial crosslinking show promise in reducing immediate complications and patient discomfort.
• Contradictory results exist regarding the comparative effectiveness of modified CXL protocols versus C-CXL.

Conclusions:

• Modified CXL techniques have successfully minimized short-term side effects associated with C-CXL.
• Further research is essential to definitively establish the optimal CXL procedure for keratoconus management.
• The ongoing investigation aims to identify a superior CXL protocol that balances efficacy, safety, and patient experience.