Corneal Crosslinking for the Treatment of Keratitis

S ince the introduction of corneal collagen crosslinking (CXL), this therapeutic procedure has been developed as an option for the management of keratoconus and other corneal ectatic conditions. A number of publications have assessed the safety and clinical efficacy of the procedure in the treatment of these conditions. Such studies seem to signify that CXL is a treatment that decreases the need for corneal transplantion.1,2 It is the only known procedure that targets the main concern in corneal ectasia—the weakening of stromal tissue. Utilizing riboflavin as a photosensitizer, with a standard concentration of 0.1%, as described in the original protocol by Wollensak et al,3 combined with application of ultraviolet-A (UV-A) light at a wavelength of 365 or 370 nm, reactive oxygen species (ROS) are produced in corneal tissue. These ROS cause covalent bonds to form between collagen fibrils, which result in an increase in tissue rigidity. The complication rate after CXL therapy is low. The most commonly described events postoperatively include stromal haze (a small minority develops permanent haze) and microbial keratitis.4,5 In most reported cases of infection, a bandage contact lens was applied after the procedure, and the descriptions of several of these subjects indicate the use of inadequate lens wear hygiene.