Abstract
SummaryCorneal collagen crosslinking (CXL) is an established safe and effective option in the treatment of early keratoconus. This presentation reviews the published evidence and personal experience with CXL in special indications.The intrinsic toxicity of the oxidative CXL process, normally causing a temporarily acellular corneal stroma to a certain depth, implies an antiseptic potential on bacteria, fungi and amebae. This has been applied to refractory corneal infections with varying success. While most available evidence is anecdotal, some prospective studies appear to confirm the usefulness of CXL as an antimicrobial treatment.CXL in keratoconus is usually applied to the central cornea and aims at preventing the progression of ectasia, with minor effect on curvature and refraction. However, our experience with CXL in cases of peripheral ectatic conditions such as Terrien's disease shows that, beyond stabilization of the process, a marked improvement in astigmatism is possible with a persistent effect after a long term follow up. The possible implications on the mechanism of action of CXL and the pathogenesis of ectasia will be discussed.
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