Rose Bengal-Green Light for Collagen Cross-linking

241 Wollensak et al reported the first application of corneal cross‐linking (CXL) for the treatment of keratoconus in 2003.[1] Thereafter, many articles were published regarding the efficacy of CXL to halt the progression of keratoconus. Long‐term studies have shown its success rate ranging from 78% to 100%.[2,3] Two studies evaluated the effect of CXL on decreasing the number for keratoplasty procedures in patients with keratoconus. Dutch Transplant Registry showed a significant decrease in the need for keratoplasty after implementation of CXL.[4] Another study showed that the need of keratoplasty for keratoconus is halved mostly due to the effect of CXL.[5] Although many modifications in CXL have been introduced over a decade from epithelium‐on to accelerated CXL to improve its outcomes, CXL has its own complications and limitations. One of the most daunting complications of CXL is endothelial decompensation that has been reported in some cases.[6] Patients with thin cornea are more susceptible to this complication due to the reduced barrier effect of riboflavin‐saturated stroma against penetrance of ultraviolet (UV) light. Some techniques, such as hypoosmolar riboflavin and contact lens‐assisted CXL, have been introduced to circumvent this problem.[7,8] Moreover, Hafezi reported CXL failure in corneas with stromal thickness less than 330 μm.[9] Cherfan et al developed corneal CXL using rose bengal with green light (RGX) instead of UV light.[10] Rose Bengal‐Green Light for Collagen Cross‐linking