Features of crosslinking methods in clinical practice

Relevance Science is actively developing in search of new, more advanced methods of strengthening the cornea. The article discusses various modifications of crosslinking, their effectiveness and prospects for the development of the technique [1-3]. Classical CXL is a standard method of strengthening the cornea, with the removal of the epithelium, the use of riboflavin and UVA irradiation. The method shows a good result in stabilizing keratoconus, but there is a risk of side effects such as corneal opacity and inflammatory reactions. For comparison, the methods of accelerated CXL, pulsating mode, transepithelial method with iontophoresis, femtocrosslinking, and combined methods were considered. Accelerated CXL allows to reduce the duration of the procedure to 2 minutes, but there is a risk of insufficient depth of the demarcation line and a potential decrease in efficiency in the long term. The pulsating mode of CXL reduces the side effects from the increase in radiation power, due to the short pulsed UVA light and improves the quality of the demarcation line. Transepithelial CXL is performed without removing the epithelium, which reduces the risk of postoperative complications, but leads to difficulty in the penetration of riboflavin molecules through the corneal layers. Transepithelial CXL with iontophoresis uses electric current to improve the penetration of modified riboflavin through the epithelium, which reduces the risk of complications, but requires a more detailed study of the voltage and exposure of iontophoresis. Combined methods: CXL with contact lenses and lenticule - used for thin corneas, increasing its thickness before the procedure. CXL in combination with excimer laser correction - the "Athens" and "Crete" protocols improve refractive indices and stabilize the cornea. Implantation of intrastromal segments with CXL is an option for more pronounced stages of keratoconus [4]. Femtocrosslinking is a method in which an intrastromal tunnel is formed for the introduction of riboflavin using a femtosecond laser, minimizing corneal damage. Currently, portable devices are being developed that allow for CXL outside the operating room and individualization of the method based on corneal topography. In the future, it is planned to introduce artificial intelligence for the diagnosis and monitoring of keratoconus progression [5]. Conclusion Corneal crosslinking continues to evolve, offering new methods for improving functional results and minimizing complications. Keywords: crosslinking; cornea; corneal epithelium; keratoconus