title: [Efficacy of corneal cross-linking for the treatment of keratoconus].
abstract: Keratoconus (KC) is a complex disease whose pathophysiology is only partially understood. The priority in management is to halt the progression of corneal deformation as soon as possible in the course of KC disease. Corneal cross-linking (CXL) is at present the only dedicated treatment for this purpose. Its biochemical mechanism of action leads to changes in the viscoelastic properties of the cornea induced by matrix bonding and renewal of keratocytes. The effect of CXL is difficult to quantify when measured in in-vivo conditions because of a lack of consistent tools adapted for clinical practice. Nevertheless, a large amount of evidence has been collected so far confirming the positive action of CXL on corneal structural reinforcement, and numerous studies have demonstrated significant efficacy in halting progression of KC with long-term follow-up. Published studies, however, are of relatively low scientific power given the great heterogeneity of the disease and the numerous associated biases in evaluation. The purpose of this paper is to summarize the consistent evidence of efficacy of CXL and to justify its role in our therapeutic armamentarium for management of progressive KC.
authors.affiliation: Centre de référence national pour le kératocône (CRNK), CHU de Bordeaux, bâtiment T, place Amélie-Raba-Léon, 33000 Bordeaux, France. Electronic address: david.touboul@chu-bordeaux.fr.
authors.forename: D
authors.initials: D
authors.lastname: Touboul
authors.affiliation: Centre de référence national pour le kératocône (CRNK), CHU de Bordeaux, bâtiment T, place Amélie-Raba-Léon, 33000 Bordeaux, France.
authors.forename: A
authors.initials: A
authors.lastname: Robinet-Perrin
authors.affiliation: Service d'ophtalmologie Pavillon-Dieulafoy, centre de référence national pour le kératocône (CRNK), hôpital Purpan, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France.
authors.forename: P
authors.initials: P
authors.lastname: Fournié
authors.affiliation: Service d'ophtalmologie Pavillon-Dieulafoy, centre de référence national pour le kératocône (CRNK), hôpital Purpan, CHU de Toulouse, place du Docteur-Baylac, TSA 40031, 31059 Toulouse cedex 9, France.
authors.forename: F
authors.initials: F
authors.lastname: Malecaze
mesh_terms: D003094:Collagen / Q000187:drug effects / Q000378:metabolism; D003315:Cornea / Q000187:drug effects*; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D006801:Humans; D007640:Keratoconus / Q000628:therapy*; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen
keywords: Biomechanics; Biomécanique; Collagen cross-linking; Cornea; Cornée; Cross-linking; Keratoconus; Kératocône; Photoréticulation du collagène; Riboflavin; Riboflavine; Viscoelasticity; Viscoélasticité