A new view on corneal crosslinking and its application in ophthalmology

    Abstract

    A new view on corneal crosslinking and its application in ophthalmology

    I.M. Kornilovsky, A.P. Gilya, R.R. Khatataev

    National Medical and Surgical Center named after N.I. Pirogov, Moscow , Russian Federation

    The accumulated experimental and clinical data on corneal crosslinking made it possible to take a different look at the possibilities of its use for therapeutic and prophylactic purposes in various ophthalmic pathologies.

    Purpose. To consider new approaches to corneal crosslinking, criteria for its evaluation and expansion of the range of its applications in ophthalmology.

    Material and methods. Eight-year experimental (20 porcine eyes, 90 rabbit eyes) and clinical studies (610 surgeries) on photorefractive and phototherapeutic surgeries with saturation of the corneal stroma with riboflavin during laser correction of ametropias and the treatment of various diseases of the cornea were analyzed. A comprehensive examination was carried out using modern diagnostic devices. Particular emphasis was placed on the technique of two-wavelength optical scanning of the cornea.

    Results. Experimental and clinical studies have shown the benefits of corneal photoablation with riboflavin.

    The use of an ultrasonic nebulizer and isotonic 0.25% riboflavin solution cooled to +5–7°С provided the effect of local aeration and hypothermia. Such technology did not affect the accuracy of refractive ablation and blocked the negative effect of induced secondary radiation on keratocytes, nerves, and the underlying layers of the cornea. This reduced the aseptic in flammatory response and the risk of developing an irreversible form of fibroplasia. Ablation with riboflavin initiated a fading effect of crosslinking. Such prophylactic crosslinking in excimer laser surgery of the cornea proved to be sufficient to compensate for the weakening of its strength and photoprotective properties. These studies predetermined the development of a new technology of therapeutic crosslinking with riboflavin activation by subablative radiation of an argon-fluorine excimer laser for keratoectasias and other pathologies of the cornea. According to OCT and densitometry, all the classic signs of traditional crosslinking were noted. Two-wavelength optical scanning of the cornea revealed the effect of dehydration and an increase in the refractive index of the cornea, which can be considered as one of the objective criteria for assessing crosslinking.

    Conclusion. Crosslinking of the cornea with argon-fluorine excimer laser radiation in ablative and subablative modes expands the range of its application for the prevention of fibroplasia, keratoectasia during photorefractive, phototherapeutic ablation, treatment of keratoconus, secondary keratoectasias and other diseases of the cornea.

    Key words: crosslinking, cornea, photorefractive and phototherapeutic keratoablation, keratoconus, secondary kertoectasias, corneal pathology