Corneal collagen crosslinking (CXL) has been available in Europe for nearly 15 years, beginning with its discovery in 1997 by the German ophthalmologist Theo Seiler and the subsequent publishing of its first clinical results in 2003 by Wollensak and colleagues.[1] The goal of CXL is to halt the progression of keratoconus, and in general, it does and often flattens keratometry by 1-2 diopters. The procedure has also been expanded to post-laser in situ keratomileusis (LASIK) ectasia.
The classic treatment involves removing the corneal epithelium, soaking the cornea with a riboflavin solution (0.1% diluted in 20% dextran), and then applying ultraviolet (UV) light to the cornea for 30 minutes, a procedure that has been coined the Dresden Protocol and is also commonly referred to as epithelium-off (epi-off) CXL. Our domestic experience has grown since its approval by the US Food and Drug Administration (FDA) in 2006, but the current treatment leaves much to be desired. While epi-off CXL has been shown to be effective in many peer-reviewed publications, there have been various modifications to further improve its efficacy and to shorten the time required for the procedure.
One of the major issues with epi-off CXL, however, is the removal of the corneal epithelium, which causes discomfort and pain, increases infection risk, and can lead to corneal haze and/or edema.
