In their article,1 Wollensak et al. demonstrated that collagen crosslinking using riboflavin and ultraviolet A (UVA) led to less edema in the crosslinked portion of the cornea than in the untreated control area. Their study propelled me to think about the potential clinical uses of this change in the swelling behavior of the corneal stroma. One potential use was discussed by Natarajan et al.,2 who suggested the possible application in corneas with borderline endothelial function not yet decompensated, such as in corneal guttata patients. I would like to suggest other potential uses for this new technology (crosslinking using riboflavin and UVA).
Crosslinking with riboflavin–UVA could be used in bullous keratopathy (BK). In BK patients, corneal edema has already occurred. Consequently, I suggest 2 steps: application of topical glycerin to dehydrate the cornea, followed by glycerin removal (washing). After these initial steps, the use of collagen crosslinking could stabilize the stroma, preventing new edema events. Similarly, collagen crosslinking could be used in the corneal edema found in keratoglobus or keratoconus patients (corneal hydrops).
In all these cases (BK, hydrops in keratoglobus, and keratoconus), the suggested method could resolve the corneal edema, improve visual acuity, increase the biomechanical strength of the cornea, reduce symptoms (such as pain and photophobia), and prevent new edema events.
1. Wollensak G, Aurich H, Pham D-T, Wirbelauer C. Hydration behavior of porcine cornea crosslinked with riboflavin and ultraviolet A. J Cataract Refract Surg. 2007;33:516-521.
2. Natarajan R, Padmanabhan P, Guruswami S., 2007. Hydration behavior of porcine cornea crosslinked with riboflavin and ultraviolet A [letter], J Cataract Refract Surg, 33, 1503.