Use of corneal cross-linking beyond keratoconus: a systemic literature review

Graefes Arch Clin Exp Ophthalmol. 2023 Sep;261(9):2435-2453. doi: 10.1007/s00417-023-05994-6. Epub 2023 Mar 7.

Abstract

Purpose: The success of corneal collagen cross-linking in altering keratoconus' clinical course has driven a search for further uses of this procedure. This literature review aims to analyze the scientific evidence available for the benefit of cross-linking in the management of ophthalmic diseases other than progressive keratoconus or ectasia induced by corneal refractive procedures.

Methods: A systemic literature review.

Results: We reviewed 97 studies. We found that collagen cross-linking can limit the progression of several other corneal ectasias, thus reducing and limiting the need for keratoplasty. Collagen cross-linking also can reduce the refractive power of the cornea and can be considered for a moderate degree of bacterial keratitis or when the organism is unidentified, which is refractive to antibiotics alone. However, the comparative rarity of these procedures has limited the extent of evidence. In fungal, Acanthamoeba, and herpes virus keratitis, the evidence is inconclusive of the safety and efficacy of cross-linking.

Conclusion: Current clinical data is limited, and laboratory data has not fully correlated with published clinical data.

Keywords: Cross-link; Ectasia; Keratoconus; PACK-CXL; Review.

Publication types

  • Systematic Review

MeSH terms

  • Collagen / therapeutic use
  • Corneal Cross-Linking
  • Cross-Linking Reagents / pharmacology
  • Cross-Linking Reagents / therapeutic use
  • Humans
  • Keratitis, Herpetic*
  • Keratoconus* / diagnosis
  • Keratoconus* / drug therapy
  • Photochemotherapy* / methods
  • Photosensitizing Agents / therapeutic use
  • Riboflavin / therapeutic use
  • Ultraviolet Rays

Substances

  • Collagen
  • Cross-Linking Reagents
  • Photosensitizing Agents
  • Riboflavin