Corneal collagen crosslinking in refractive surgery

PURPOSE OF REVIEW: To describe the development and uses of corneal collagen crosslinking (CXL) in association with keratorefractive procedures as well as in the treatment of progressive keratoconus and progressive postlaser in-situ keratomileusis (post-LASIK) keratectasia. RECENT FINDINGS: CXL has been shown to be effective in slowing, halting or reversing progressive ectasia in both keratoconus and progressive post-LASIK keratectasia by means of corneal stiffening. Thus, it is the only treatment option currently available that addresses the underlying progression of ectactic conditions. Combining CXL with keratorefractive procedures, such as intrastromal corneal ring segment implantation and photorefractive keratectomy, is a promising therapeutic alternative to penetrating keratoplasty or lamellar keratoplasty that in many cases can improve visual acuity, stabilize ectasia, and delay or even prevent the need for more invasive procedures. SUMMARY: The stiffening effect of CXL has made it a promising alternative in the ophthalmologist's armamentarium for treatment of progressive keratoconus and progressive post-LASIK keratectasia. Future studies are needed to determine the long-term stability of CXL, as well as to address possible complications.