New treatment modalities of collagen cross-linking

Session Details

Session Title: Cross-Linking

Session Date/Time: Tuesday 10/10/2017 | 14:00-16:30

Paper Time: 14:00

Venue: Room 4.6

First Author: : J.Brekelmans THE NETHERLANDS

Co Author(s): :    M. Dickman   A. Goz   A. Brandis   A. Marcovich   A. Scherz   R. Nuijts     

Abstract Details

Purpose:

The field of corneal collagen cross-linking (CXL) has been revolutionized and dominated by Riboflavin/Ultraviolet A (RF/UVA) in the treatment of corneal ectasia since its introduction over a decade ago. Other CXL modalities with different mechanisms of action, benefits, and side effects, aiming to overcome the downsides of RF/UVA CXL and to expand the spectrum of applications, have however been tested over the years. The current literature review sets out to identify, describe and compare all CXL modalities with corneal applications known in the literature.

Setting:

Academic research institute. Literature study.

Methods:

A structured search was conducted in the online databases MEDLINE, EMBASE, CENTRAL, and Web of Science. The search included free and relevant database subject headings, covering animal and human studies (Population), all ocular tissues (Context), and cross-linking or stiffening reporting (Outcome). Conference abstracts and grey literature was included to identify unique modalities.

Results:

Two major groups for corneal cross-linking could be identified: pharmacological and chromophore cross-linkers, with 4 and 2 different modalities known in the literature respectively. RF/UVA is by far the most investigated CXL modality. CXL was suggested as treatment for 11 different corneal pathologies, with keratoconus/ectasia clearly dominating. Clinically, only RF/UVA has been applied as first line treatment for corneal ectasia, and experimentally in the treatment of infectious keratitis.

Conclusions:

RF/UVA has been a game changer in the treatment of corneal ectasia, providing a conservative treatment option and decreasing the need for corneal transplantations. To overcome its downsides and to expand the treatment spectrum, several research groups developed alternative CXL modalities. Despite promising results in in vivo and ex vivo animal models, none of these modalities have yet been applied clinically. Thus, clinically CXL treatment still lacks diversity, resulting in patients being excluded from CXL due to unsuitability for the currently exclusively available RF/UVA treatment. More studies should be undertaken to evaluate other CXL modalities, experimentally and for clinical use.

Financial Disclosure:

gains financially from product or procedure presented, receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented