Collagen cross-linking: a new treatment paradigm in corneal disease - a review
ABSTRACT The last 2 years has seen a marked increase in the prominence of corneal collagen cross-linking as a treatment strategy for progressive keratoconus. This interest has arisen from a body of laboratory evidence documenting the biomechanical and cellular changes induced by cross-linking. The findings of this research provide a plausible rationale for its use in keratoconus to retard the progression of this common disease. The rapidly growing number of clinical reports suggests, not only a consistent stabilizing effect of cross-linking, but that a variable improvement in corneal shape and visual function may also occur in some patients. However, the marked variation in the clinical course of keratoconus, together with the challenges of accurately evaluating refractive error, visual acuity and even corneal shape in this condition, demands further evidence from randomized controlled clinical trials. The aim of this review is to summarize the theoretical basis and risks of corneal collagen cross-linking, along with the available evidence for its use in keratoconus and other corneal disease states.
Full-textDOI: · Available from: Grant R Snibson, Jul 01, 2015
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ABSTRACT: Recent studies have reported collagen cross-linking after exposure to riboflavin followed by ultraviolet-A (UVA) exposure. This study is the first to investigate the effect of a riboflavin-containing primer on adhesive interface stability and dentinal matrix metalloproteinase activity. Human dentin was etched with 35% phosphoric acid, treated with 0.1% riboflavin, exposed to UVA for 2 min, and bonded with a two-step etch-and-rinse adhesive. Adhesive was applied to control specimens without riboflavin/UVA. Specimens were subjected to microtensile bond strength tests and pulled to failure after storage for 24 hrs, 6 mos, or 1 yr. Interfacial nanoleakage was evaluated by light and transmission electron microscopy. To investigate dentinal matrix metalloproteinase activity, we performed correlative zymographic assays on protein extracts obtained from phosphoric-acid-etched dentin powder with or without riboflavin/UVA treatment and XP Bond. Ultraviolet-activated riboflavin treatment increased the immediate bond strength to dentin at all aging intervals (p < 0.05 vs. control) and decreased interfacial nanoleakage in aged specimens (1 yr; p < 0.05). Zymograms revealed that riboflavin/UVA pre-treatment inhibited dentinal matrix metalloproteinase activity (especially MMP-9). In conclusion, dentinal collagen cross-linking induced by riboflavin/UVA increased immediate bond strength, stabilized the adhesive interface, and inhibited dentin matrix metalloproteinases, thereby increasing the durability of resin-dentin bonds.Journal of dental research 09/2011; 90(12):1439-45. DOI:10.1177/0022034511423397 · 4.14 Impact Factor
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ABSTRACT: We present the case of an 11-year-old boy who had bilateral implantation of intrastromal corneal ring segments for progressive keratoconus and poor vision. No intraoperative or postoperative complications were seen, and 1 year postoperatively, the patient maintained good spectacle-corrected vision. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.Journal of Cataract and Refractive Surgery 01/2011; 37(1):201-5. DOI:10.1016/j.jcrs.2010.10.023 · 2.55 Impact Factor
- International ophthalmology clinics 01/2011; 51(4):157-66. DOI:10.1097/IIO.0b013e31822d65c6