Potential Effects of Corneal Cross-Linking upon the Limbus.
Corneal cross-linking is nowadays the most used strategy for the treatment of keratoconus and recently it has been exploited for an increasing number of different corneal pathologies, from other ectatic disorders to keratitis. The safety of this technique has been widely assessed, but clinical complications still occur. The potential effects of cross-linking treatment upon the limbus are incompletely understood; it is important therefore to investigate the effect of UV exposure upon the limbal niche, particularly as UV is known to be mutagenic to cellular DNA and the limbus is where ocular surface tumors can develop. The risk of early induction of ocular surface cancer is undoubtedly rare and has to date not been published other than in one case after cross-linking. Nevertheless it is important to further assess, understand, and reduce where possible any potential risk. The aim of this review is to summarize all the reported cases of a pathological consequence for the limbal cells, possibly induced by cross-linking UV exposure, the studies donein vitroorex vivo, the theoretical bases for the risks due to UV exposure, and which aspects of the clinical treatment may produce higher risk, along with what possible mechanisms could be utilized to protect the limbus and the delicate stem cells present within it.
School of Biomedical Sciences, University of Ulster, Coleraine BT52 1SA, UK; Cathedral Eye Clinic, Academy Street, Belfast BT15 1ED, UK.
Johnny E
0000-0001-8451-9421
JE
Moore
School of Biomedical Sciences, University of Ulster, Coleraine BT52 1SA, UK.
Davide
0000-0001-7639-0015
D
Schiroli
School of Biomedical Sciences, University of Ulster, Coleraine BT52 1SA, UK.
C B Tara
0000-0002-7659-9326
CB
Moore
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