Switzerland, particularly Zurich, has been a leader in corneal cross-linking (CXL) research and innovation for over two decades, explained ELZA’s Medical Director, Prof. Farhad Hafezi, MD, PhD, FARVO, in this month’s issue of Cataract and Refractive Surgery Today.
The current context of CXL in Switzerland is that Swiss surgeons typically perform epithelium-off (epi-off) CXL using either the Dresden or accelerated CXL (A-CXL) protocol. However, recent advancements from ELZA’s research group include the development of an ultrastrong epi-off CXL protocol, which achieves Dresden-like corneal strengthening in one-third the time. This new protocol utilizes UV irradiation at an intensity of 18 mW/cm² for 9 minutes and 15 seconds, delivering a UV fluence of 10 J/cm², compared to the Dresden protocol’s 5.4 J/cm².
Furthermore, a new epi-on CXL protocol that does not require oxygen or iontophoresis to work effectively has also been developed by ELZA’s surgeons and researchers. This method employs a riboflavin solution with penetration enhancers, providing similar corneal stiffening effects as epi-off CXL. One advantage of the epi-on procedure is that it circumvents the potential drawbacks associated with removing and regrowing the epithelium. Preclinical data on this protocol are expected to be published soon.
A Instituto ELZA is also unique in possessing three cutting-edge corneal biomechanical assessment instruments (CorVis ST, BOSS and OCT Elastography), which offer new insights into keratoconus. Additionally, the team is working on improving photoactivated chromophore for keratitis-CXL (PACK-CXL) for the treatment of infectious keratitis. They have found that higher UV fluences are required to treat many cases of infectious keratitis successfully.
ELZA’s researchers are also the first to evaluate the combined effect of PACK-CXL with both rose bengal/green light and riboflavin/UV-A in the same session for treating recalcitrant fungal and Acanthamoeba keratitis. These innovations and discoveries in CXL in Switzerland continue to shape the future of corneal cross-linking and provide new avenues for treating various eye conditions.
