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Title: Corneal Cross-Linking: The Evolution of Treatment for Corneal Diseases
Authors: Wu, Duoduo 
Lim, Dawn Ka-Ann 
Lim, Blanche Xiao Hong
Wong, Nathan
Hafezi, Farhad
Manotosh, Ray 
Lim, Chris Hong Long
Keywords: corneal cross-linking
customised CXL
infectious keratitis
Issue Date: 19-Jul-2021
Publisher: Frontiers Media S.A.
Citation: Wu, Duoduo, Lim, Dawn Ka-Ann, Lim, Blanche Xiao Hong, Wong, Nathan, Hafezi, Farhad, Manotosh, Ray, Lim, Chris Hong Long (2021-07-19). Corneal Cross-Linking: The Evolution of Treatment for Corneal Diseases. Frontiers in Pharmacology 12 : 686630. ScholarBank@NUS Repository.
Rights: Attribution 4.0 International
Abstract: Corneal cross-linking (CXL) using riboflavin and ultraviolet A (UVA) light has become a useful treatment option for not only corneal ectasias, such as keratoconus, but also a number of other corneal diseases. Riboflavin is a photoactivated chromophore that plays an integral role in facilitating collagen crosslinking. Modifications to its formulation and administration have been proposed to overcome shortcomings of the original epithelium-off Dresden CXL protocol and increase its applicability across various clinical scenarios. Hypoosmolar riboflavin formulations have been used to artificially thicken thin corneas prior to cross-linking to mitigate safety concerns regarding the corneal endothelium, whereas hyperosmolar formulations have been used to reduce corneal oedema when treating bullous keratopathy. Transepithelial protocols incorporate supplementary topical medications such as tetracaine, benzalkonium chloride, ethylenediaminetetraacetic acid and trometamol to disrupt the corneal epithelium and improve corneal penetration of riboflavin. Further assistive techniques include use of iontophoresis and other wearable adjuncts to facilitate epithelium-on riboflavin administration. Recent advances include, Photoactivated Chromophore for Keratitis-Corneal Cross-linking (PACK-CXL) for treatment of infectious keratitis, customised protocols (CurV) utilising riboflavin coupled with customised UVA shapes to induce targeted stiffening have further induced interest in the field. This review aims to examine the latest advances in riboflavin and UVA administration, and their efficacy and safety in treating a range of corneal diseases. With such diverse riboflavin delivery options, CXL is well primed to complement the armamentarium of therapeutic options available for the treatment of a variety of corneal diseases. © Copyright © 2021 Wu, Lim, Lim, Wong, Hafezi, Manotosh and Lim.
Source Title: Frontiers in Pharmacology
ISSN: 1663-9812
DOI: 10.3389/fphar.2021.686630
Rights: Attribution 4.0 International
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