An Insight into Practice Patterns for Collagen Crosslinking Treatment for Corneal Ectasias

Not too long ago, the only treatment options available for patients with ectatic corneal diseases were contact lenses (for early disease) and keratoplasty (for advanced ectasias and contact lens intolerent cases). In the early part of the last decade, Theo Seiler & co-workers, with their innovative discovery of corneal collagen cross-linking (CXL), gave us a new dimension in the treatment of keratectasia, with the potential of halting the disease process. In its original form, as recommended by the Dresden Protocol, CXL involved intermittent 30 minutes of instillation of isotonic riboflavin (Vitamin B2 with dextran) after epithelial debridement, followed by 30 minutes of irradiation of UVA at 3mW/ cm2. Over the subsequent years, various scientists have modified the original protocol to try various combinations of energy and exposure of UVA (Table2), coupled with modifications in constituents and strength of Riboflavin solution (Table1). While the original indication for cross-linking was Keratoconus with documented progression, it is being increasing attempted in a variety of expanded indication that include other forms of ectasia, microbial keratitis & chronic corneal edema.