Keratoconus treatment with corneal collagen crosslinking

Corneal cross-linking (CXL) is a method used to create strong bonds in the collagen of the cornea through a photochemical reaction of collagen fibers under the influence of riboflavin and UVA rays. Тhis method is used to prevent the progression of corneal ectasia in keratoconus, aiming to prevent progressive vision loss and avoid corneal transplantation. Cross-linking results in improvements in visual, keratometric, and topographic values. There are two main techniques: transepithelial and epithelial removal techniques. The Dresden protocol recommends epithelial removal techniques with UVA radiation for 30 minutes. The downside of this technique is the pain, which lasts for at least 72 hours. The effectiveness of cross-linking, pain treatment, and the reporting of postoperative keratometric values in patients with keratoconus were evaluated one year after the intervention. The study included 45 patients with keratoconus who underwent cross-linking based on the Dresden protocol. We created an epithelial flap with a diameter of 8 mm by applying alcohol 28% for 15 seconds. We applied 30 minutes of riboflavin 5-phosphate 0.1% within 2 minutes, followed by UVA radiation (370 nm, 3m W/cm²). After repositioning the epithelial flap, therapeutic contact lenses were placed. Visual acuity and keratometric values improved after the intervention. One year later, topography showed a reduction in keratometric values by 1.75 D in 16% or 7 patients, and 2.00 D in 84% or 38 patients. Postoperative pain was absent in 97.7% or 44 patients. Strong postoperative pain was present in one patient or 2.3%. No postoperative complications were recorded in any patient. Epithelial flap cross-linking provides the best results for managing postoperative pain, reducing keratometric values, and improving vision