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Vitamin B2 in Corneal Surgery—Riboflavin and Collagen Cross-Linking

Published Online: September 21st 2012 US Ophthalmic Review, 2012;5(2):105-6 DOI: http://doi.org/10.17925/USOR.2012.05.02.105
Authors: Spencer Thornton
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Abstract:
Overview

Cross-linking of collagen refers to the ability of collagen fibrils to form strong chemical bonds with adjacent fibrils. Corneal collagen cross-linking (CXL) with vitamin B2 activated by ultraviolet offers a new method for stabilization of unstable or weakened corneal tissue in cases of ectasia, dystrophy and irregular post-surgical healing.

Keywords

Vitamin B2, corneal surgery, limbal thinning, Riboflavin CXL

Article:

Because of increasing numbers of cases with corneal and limbal thinning, ways to stop or reverse the degenerative changes induced by corneal surgery (radial incisions, laser-assisted in situ keratomileusis (LASIK), lamellar keratoplasty) and degenerative diseases such as keratoconus have become imperative. These include several surgical and non-surgical modalities (vitamin therapy, ultraviolet (UV) light therapy and cross-linking).

Originally developed as a new method to strengthen the weakened corneas of keratoconus, riboflavin CXL has been shown to strengthen the corneas in post-LASIK ectasias and in marginal corneal dystrophies.1,2 Progressive irregular thinning (ectasia) is problematic and possible with any LASIK procedure.

Cross-linking of collagen refers to the ability of collagen fibrils to form strong chemical bonds with adjacent fibrils. Some naturally occurs in the cornea with aging (as in other parts of the body), but for immediate therapeutic effect, chemical agents (UV-activated riboflavin) are used. In a number of studies, CXL has been shown to effectively stop the advancement of ectasia in eyes following excimer laser ablation. In an early German study with corneal cross-linking, the biomechanical status of the cornea was stabilized with a halting of the refractive and topographic progression of ectasia.1

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Disclosure

The authors have no conflicts of interest to declare.

Correspondence

Spencer P Thornton, MD, FACS, Clinical Professor of Ophthalmology at the University of Tennessee, Memphis, US. E: sthornton@biosyntrx.com

Support

The publication of this article was supported by Biosyntrx

Received

2012-07-19T00:00:00

References

  1. Schnitzler E, Spörl E, Seiler T, Irradiation of cornea with ultraviolet light and riboflavin administration as a new treatment for erosive corneal processes, preliminary results in four patients, Klin Monatsbl Augenheilkd, 2000;217:190–3.
  2. Li G, Fan ZJ, Peng XJ, Corneal collagen crosslinking for corneal ectasia of post-LASIK: one year results, Int J Ophthalmol. 2012;5(2):190–5.
  3. Stojanovic A, Zhang J, Chen X, et al., Topography-guided transepithelial surface ablation, J Refract Surg, 2010;26(2):145–52.
  4. Vinciguerra P,Camesasca F, Albe E, Trazza S, Corneal crosslinking for ectasia after excimer laser refractive surgery, J Refract Surg, 2010;26:486–97.
  5. Greenstein S, Fry K, Hersh M, Hersh P, Higher-order aberrations after corneal collagen crosslinking for keratoconus and corneal ectasia, J Cat Refract Surg, 2012;38:293–301.
  6. Personal communication.
  7. Stulting RD, The Risks of CXL, J Cat & Refract Surg TODAY, 2012;12(5):48–9.
  8. Asri D, Touboul D, Fournié P, et al., Corneal collagen crosslinking in progressive keratoconus: multicenter results from the French National Reference Center for Keratoconus, J Cataract Refract Surg, 2011;37(12):2137–43.
  9. Greenstein SA, Kristen LF, Hersh MJ, Hersh PS, Higher-order aberrations after corneal collagen crosslinking for keratoconus and corneal ectasia, J Cataract Refract Surg, 2012;38:292–302.
  10. Stein R, Stein R, Corneal Collagen Crosslinking: A Major Breakthrough in the Management of Keratoconus, Pellucid Marginal Degeneration, and Ectasia after LASIK, Ophth Rounds, 2011;9(1):1–5.
  11. Filippello M, Stagni E, O’Brart D, Transepithelial corneal collagen crosslinking: Bilateral study, J Cataract Refract Surg, 2012;38;283–91.

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