Recent Innovations in Collagen Corneal Cross-linking; a Mini Review

Iraklis Vastardis1, *, Brigitte Pajic-Eggspuehler1, Charis Nichorlis1, Jörg Mueller1, 2, Bojan Pajic1, 2, 3
1 Swiss Eye Research Foundation, Eye Clinic ORASIS, Titlisstrasse 44, 5734 Reinach, Switzerland
2 University of Novi Sad, Faculty of Physics, Novi Sad, Serbia
3 Medical faculty, Military Medical Academy, University of defence Belgrade, Serbia

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© 2017 Vastardis et al..

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Swiss Eye Research Foundation, Eye Clinic ORASIS, Titlisstrasse 44, 5734 Reinach, Switzerland; Tel: +41627656080; Fax: +41627656081; E-mail:



The introduction of corneal cross-linking (CXL) with ultraviolet-A (UVA) and Riboflavin photosensitizer (Vit B2) from Seiler et al., revolutionized the treatment of Keratoconus and other corneal ectatic diseases.

Today, the commonly known epithelium off Dresden protocol is in clinical use for the last 15 years with great success and regarded by many as the golden standard.


With several studies demonstrating its simplicity, efficacy and safety this revolutionary method, paved the way for new therapies and strategies in the treatment of corneal ectatic diseases and changed our understanding in corneal biomechanics. Recent scientific and technological advances enabled the creation of various modifications of the initial CXL protocol and the formation of new ones.


This work highlights the recent advances of CXL, such as the role of oxygen, higher fluence and shorter irradiation times as well as the various clinical applications and updates of this method.

Keywords: Corneal Cross Linking, Riboflavin, Higher fluence, Keratoconus, Dresden Protocol, Biomachanics.