Crosslinking treatment of progressive keratoconus: new hope.
OBJECTIVE
A new method has been introduced for the treatment of progressive keratoconus using collagen crosslinking by the photosensitzer riboflavin and ultraviolet A-light. Biomechanical measurements have shown an impressive increase in corneal rigidity of 328.9% in human corneas after crosslinking.


RESULTS
The 3 and 5-year results of the Dresden clinical study have shown that in all treated 60 eyes the progression of keratoconus was at least stopped ('freezing'). In 31 eyes there also was a slight reversal and flattening of the keratoconus by up to 2.87 diopters. Best corrected visual acuity improved slightly by 1.4 lines. So far, over 150 keratoconus patients have received crosslinking treatment in Dresden. Laboratory studies have revealed that the maximum effect of the treatment is in the anterior 300 mum of the cornea. As for the corneal endothelium, a cytotoxic level for endothelium was found to be 0.36 mW/cm which would be reached in human corneas with a stromal thickness of less than 400 mum.


CONCLUSIONS
Collagen crosslinking by the photosensitzer riboflavin and ultraviolet A-light is an effective means for stabilizing the cornea in keratoconus. Collagen crosslinking might become the standard therapy for progressive keratoconus in the future diminishing significantly the need for corneal transplantation. Preoperative pachymetry and individual control of the ultraviolet A-irradiance before each treatment are mandatory. The treatment parameters must not be varied.
Wollensak
Gregor
G
Department of Ophthalmology, Universitatsklinikum CGC, Dresden, Germany. gwollens@hotmail.com
D000818:Animals; D003094:Collagen / Q000378:metabolism / Q000528:radiation effects*; D003315:Cornea / Q000378:metabolism / Q000473:pathology; D003432:Cross-Linking Reagents / Q000528:radiation effects*; D018450:Disease Progression; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy* / Q000473:pathology; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D012256:Riboflavin / Q000627:therapeutic use*; D016896:Treatment Outcome; D014466:Ultraviolet Rays
D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin