Journal of Refractive Surgery

Correspondence Free

Corneal Cross-linking Standardized Terminology

Marco Lombardo, MD, PhD; Sebastiano Serrao, MD, PhD

Abstract

Click here to read the article.

Abstract

Click here to read the article.

We read with interest the editorial entitled “Corneal Cross-linking (CXL): Standardizing Terminology and Protocol Nomenclature.”1 We would like to clarify that we recommended the use of the term “corneal cross-linking” in a previous publication.2 For the sake of completeness, a comprehensive bibliography supporting this claim is added here for the journal's readers.3–6

In the same editorial, we did not agree with the term “prophylactic CXL,” which is misleading and does not have scientific or clinical support. Recommending the use of CXL in combination with corneal refractive surgery to prevent corneal ectasia is erroneous because the primary factor to avoid this complication remains the accurate patient selection.

Marco Lombardo, MD, PhD

Sebastiano Serrao, MD, PhD

Rome, Italy

References

  1. Randleman JB, Santhiago MR, Kymionis GD, Hafezi F. Corneal cross-linking (CXL): standardizing terminology and protocol nomenclature. J Refract Surg. 2017;33(11):727–729. doi:10.3928/1081597X-20170925-01 [CrossRef]
  2. Lombardo M, Pucci G, Barberi R, Lombardo G. Interaction of ultraviolet light with the cornea: clinical implications for corneal crosslinking. J Cataract Refract Surg. 2015;41:446–459. doi:10.1016/j.jcrs.2014.12.013 [CrossRef]
  3. Labate C, De Santo MP, Lombardo G, Lombardo M. Understanding of the viscoelastic response of the human corneal stroma induced by riboflavin/UV-A cross-linking at the nano level. PLoS One. 2015;10:e0122868. doi:10.1371/journal.pone.0122868 [CrossRef]
  4. Hayes S, Kamma-Lorger CS, Boote C, et al. The effect of riboflavin/UVA collagen cross-linking therapy on the structure and hydrodynamic behaviour of the ungulate and rabbit corneal stroma. PLoS One. 2013;8:e52860. doi:10.1371/journal.pone.0052860 [CrossRef]
  5. Brummer G, Littlechild S, McCall S, Zhang Y, Conrad GW. The role of nonenzymatic glycation and carbonyls in collagen cross-linking for the treatment of keratoconus. Invest Ophthalmol Vis Sci. 2011;52:6363–6369. doi:10.1167/iovs.11-7585 [CrossRef]
  6. Zhang Y, Conrad AH, Conrad GW. Effects of ultraviolet-A and riboflavin on the interaction of collagen and proteoglycans during corneal cross-linking. J Biol Chem. 2011;286:13011–13022. doi:10.1074/jbc.M110.169813 [CrossRef]

Reply

We thank Drs. Lombardo and Serrao for their added bibliography providing a more compete background as to why we advocate for the use of corneal cross-linking (CXL) as the best general term to describe the cross-linking procedure.

We share their concerns regarding the term “prophylactic CXL,” and specifically set out to clarify in our editorial1 that “By defining these terms, we are not advocating for specific indications, merely working to clarify the discussions surrounding them.” To be clear, we do not advocate the use of CXL at the time of refractive surgery as a prophylactic measure. Rather, we agree with the authors that to date the science supporting this technique is sparse at best. However, it is a reality that this treatment strategy is in practice and being discussed at meetings and in the literature. To better recognize which approach is discussed in future publications, we believed it appropriate to provide a standardized general term to best identify publications and presentations that fit this theme to improve our collective ability to evaluate this contentious topic.

J. Bradley Randleman, MD

Marcony R. Santhiago, MD, PhD

George D. Kymionis, MD, PhD

Farhad Hafezi, MD, PhD

Los Angeles, California

Reference

  1. Randleman JB, Santhiago MR, Kymionis GD, Hafezi F. Corneal cross-linking (CXL): standardizing terminology and protocol nomenclature. J Refract Surg. 2017;33(11):727–729. doi:10.3928/1081597X-20170925-01 [CrossRef]
Authors

The authors have no financial or proprietary interest in the materials presented herein.

10.3928/1081597X-20180206-02

Sign up to receive

Journal E-contents