Therapeutic and inducing effect of corneal crosslinking on infectious keratitis.

The corneal crosslinking (CXL) with riboflavin and ultraviolet-A (UVA) is a new therapy method to successfully treat infectious keratitis in clinical practice. However, there are rare reports on the complications of CXL such as the secondary keratitis. The diverse clinical outcomes on keratitis have highlighted the necessity to further evaluate the efficacy and complications of CXL. We reviewed the positive and negative reports on UVA/riboflavin related with keratitis and provided our opinion on the therapeutic and side effect of UVA/riboflavin crosslinking on keratitis.

Corrigendum to "A Review of Collagen Cross-Linking in Cornea and Sclera".

[This corrects the article DOI: 10.1155/2015/289467.].

Combining corneal crosslinking and phakic toric Implantable Collamer Lenses for the treatment of keratectasia: A case report.

The present study reports the use of a phakic toric Implantable Collamer Lens (ICL) that improved the refraction correction of high myopia and astigmatism in a case of keratectasia following corneal cross-linking. A 31-year-old male was diagnosed with keratectasia 12 years after laser-assisted in situ keratomileusis (LASIK). Following LASIK, the manifest refraction was -3.50-2.25×90 [0.1 logarithmic expression (LogMAR) best corrected visual acuity (BVCA)] in the right eye and -8.00-3.50×175 (0.3 LogMAR BCVA) in the left eye, with a LogMAR uncorrected distance visual acuity (UDVA) of 0.8 and a 'counting fingers' value of 3 ft (CF @3 ft) in the left and right eyes, respectively. Riboflavin/ultraviolet A light (UVA) corneal crosslinking (CXL) was conducted on both eyes. Seven months after cross-linking, LogMAR UDVA was 0.4, the manifest refraction was -2.75-2.50×85 and LogMAR BCVA was 0.1 in the right eye. In the left eye, LogMAR UDVA was CF @3 ft, the manifest refraction was -15.00 and LogMAR BCVA was 0.3. The corneal topography was stable 7 months after CXL. Phakic toric ICL was implanted to correct the refractive error, following which the LogMAR UDVA improved to 0.1 in the right eye and 0.3 in left eye, and visual acuity remained stable for 6 months after ICL implantation. In conclusion, combining riboflavin/UVA corneal cross-linking and phakic toric ICL implantation may be an alternative in the correction of high refractive error in patients with keratectasia.

A review of collagen cross-linking in cornea and sclera.

Riboflavin/UVA cross-linking is a technique introduced in the past decades for the treatment of keratoconus, keratectasia, and infectious keratitis. Its efficacy and safety have been investigated with clinical and laboratory studies since its first clinical application by Wollensak for the treatment of keratoconus. Although its complications are encountered during clinical practice, such as infection inducing risk, minimal invasion merits a further investigation on its future application in clinical practice. Recently, collagen cross-linking in sclera shows a promising prospect. In present study, we summarized the representative studies describing the clinical and laboratory application of collagen cross-linking published in past decades and provided our opinion on the positive and negative results of cross-linking in the treatment of ophthalmic disorders.

A short-term study of corneal collagen cross-linking with hypo-osmolar riboflavin solution in keratoconic corneas.

AIM: To report the 3mo outcomes of collagen cross-linking (CXL) with a hypo-osmolar riboflavin in thin corneas with the thinnest thickness less than 400 µm without epithelium. METHODS: Eight eyes in 6 patients with age 26.2±4.8y were included in the study. All patients underwent CXL using a hypo-osmolar riboflavin solution after its de-epithelization. Best corrected visual acuity, manifest refraction, the thinnest corneal thickness, and endothelial cell density were evaluated before and 3mo after the procedure. RESULTS: The mean thinnest thickness of the cornea was 408.5±29.0 µm before treatment and reduced to 369.8±24.8 µm after the removal of epithelium. With the application of the hypo-osmolar riboflavin solution, the thickness increased to 445.0±26.5 µm before CXL and recover to 412.5±22.7 µm at 3mo after treatment, P=0.659). Before surgery, the mean K-value of the apex of the keratoconus corneas was 57.6±4.0 diopters, and slightly decreased (54.7±4.9 diopters) after surgery (P=0.085). Mean best-corrected visual acuity was 0.55±0.23 logarithm of the minimal angle of resolution, and increased to 0.53±0.26 logarithm after surgery (P=0.879). The endothelial cell density was 2706.4±201.6 cells/mm(2) before treatment, and slightly decreased (2641.2±218.2 cells/mm(2)) at last fellow up (P=0.002). CONCLUSION: Corneal collagen cross-linking with a hypo-osmolar riboflavin in thin corneas seems to be a promising treatment. Further study should be done to evaluate the safety and efficiency of CXL in thin corneas for the long-term.

Evaluation of the in vitro antimicrobial properties of ultraviolet A/riboflavin mediated crosslinking on Candida albicans and Fusarium solani.

AIM: To evaluate the antimicrobial properties of ultraviolet A (UVA) (365 nm)/riboflavin against Candida albicans and Fusarium solani. METHODS: Two fungus isolates were cultured in vitro and prepared with 10-fold serial PBS dilutions of cell concentration. For each dilution of fungus suspension, the concentration (colony-forming units/mL, CFU/mL) and the inactivation ratio of fungal cells were evaluated under 4 conditions: no treatment (control), UVA (365 nm)/riboflavin, riboflavin, and UVA (365 nm). RESULTS: The cell concentration decreased in UVA (365 nm)/riboflavin group for Candida albicans at each dilution and Fusarium solani at dilutions of 10(4), 10(3), 10(2) CFU/mL, when compared with that in control, riboflavin, and UVA (365 nm) groups (P<0.01). No difference of cell concentration was detected amongst the culture of control, riboflavin, and UVA (365 nm) groups for the two fungus. There is a negative correlation between suspension concentration (log-transformed) and the inactivation ratio in UVA (365 nm)/riboflavin group for Candida albicans and Fusarium solani (P<0.01). CONCLUSION: According to the standard protocol of corneal collagen cross-linking, UVA (365 nm)/riboflavin combination treatment is found to moderately inactivate the viability of Candida albicans and Fusarium solani in vitro. The inactivation ratio was found to increase with the decrease of cell concentration under UVA (365 nm)/riboflavin condition.