Experimental Use of Ozone in Cross-Linking: Transforming Keratoconus Management

Keratoconus is a progressive corneal disorder characterized by thinning of the stromal layer. Corneal cross-linking (CXL), a widely used treatment, focuses on improving corneal strength by enhancing collagen cross-links. Alternative methods are being explored to increase the efficacy of CXL. This study aims to evaluate whether ozone, as a strong oxygen donor, can be utilized as an adjuvant or standalone cross-linking agent in an in vivo model.

The study involved 12 New Zealand albino rabbits, which were divided into three treatment groups, each receiving a different therapy: (1) CXL, (2) ozone, and (3) CXL combined with ozone (CXL+ozone). Corneal Visualization Scheimpflug Technology (Corvis ST), Anterior Segment Optical Coherence Tomography (AS-OCT), and Corneal Confocal Microscopy (CCM) measurements were performed post-procedure.

Ozone therapy did not result in statistically significant differences compared to CXL in biomechanical parameters. Corvis ST measurements were not significantly different between groups. AS-OCT revealed full-thickness stromal brightness in the CXL+ozone group. CCM imaging showed hyperreflectivity limited to the anterior stroma in the CXL and ozone groups but distributed throughout the stroma in the CXL+ozone group. No adverse effects were observed.

Ozone therapy may enhance CXL efficacy and serves as a potential alternative. Its affordability, shorter duration, and comparable clinical outcomes make it particularly promising for resource-limited settings.