Anterior Segment, Corneal and External Disorders
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Vitamin B2 in Corneal Surgery—Riboflavin and Collagen Cross-Linking

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Published Online: Sep 21st 2012 US Ophthalmic Review, 2012;5(2):105-6 DOI:
Authors: Spencer Thornton
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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.


Vitamin B2, corneal surgery, limbal thinning, Riboflavin CXL


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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Article Information:

The authors have no conflicts of interest to declare.


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


The publication of this article was supported by Biosyntrx




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