The Logic Behind Customized Corneal Crosslinking

  • Theo G. SeilerEmail author
  • Tobias Koller


Customized CXL is a new innovative technique in corneal crosslinking, where only the pathologic region of the keratoconus cornea is treated and not the entire cornea as in standard CXL. Clinical advantages are a shorter epithelial healing time, a more frequent and stronger corneal flattening, and a better regularization of the cornea compared to standard CXL.


Customized crosslinking Customized CXL Cornea CXL Keratoconus Biomechanics 


  1. 1.
    Krachmer JH. Eye rubbing can cause keratoconus. Cornea. 2004;23:539–40.CrossRefGoogle Scholar
  2. 2.
    Sugar J, Macsai MS. What causes keratoconus? Cornea. 2012;31:716–9.CrossRefGoogle Scholar
  3. 3.
    Valgaeren H, Koppen C, Van Camp G. A new perspective on the genetics of keratoconus: why have we not been more successful? Ophthalmic Genet. 2017;7:1–17.Google Scholar
  4. 4.
    Galvis V, Sherwin T, Tello A, et al. Keratoconus: an inflammatory disorder? Eye (Lond). 2015;29:843–59.CrossRefGoogle Scholar
  5. 5.
    Roberts CJ, Dupps WJ Jr. Biomechanics of corneal ectasia and biomechanical treatments. J Cataract Refract Surg. 2014;40:991–8.CrossRefGoogle Scholar
  6. 6.
    Scarcelli G, Besner S, Pineda R, et al. Biomechanical characterization of keratoconus corneas ex vivo with Brillouin microscopy. Invest Ophthalmol Vis Sci. 2014;55:4490–5.CrossRefGoogle Scholar
  7. 7.
    The International Commission on Non-Ionizing Radiation Protection. Health Physics. 2013;105(3):271–95.Google Scholar
  8. 8.
    Seiler TG, Fischinger I, Senfft T, et al. Intrastromal application of riboflavin for corneal crosslinking. Invest Ophthalmol Vis Sci. 2014;55:4261–5.CrossRefGoogle Scholar
  9. 9.
    Hammer A, Richoz O, Arba Mosquera S, et al. Corneal biomechanical properties at different corneal cross-linking (CXL) irradiances. Invest Ophthalmol Vis Sci. 2014;55:2881–1884.CrossRefGoogle Scholar
  10. 10.
    Wernli J, Schumacher S, Spoerl E, et al. The efficacy of corneal cross-linking shows a sudden decrease with very high intensity UV light and short treatment time. Invest Ophthalmol Vis Sci. 2013;54:1176–80.CrossRefGoogle Scholar
  11. 11.
    Ehmke T, Seiler TG, Fischinger I, et al. Comparison of Corneal Riboflavin Gradients Using Dextran and HPMC Solutions. J Refract Surg. 2016;32:798–802.CrossRefGoogle Scholar
  12. 12.
    Seiler TG, Fischinger I, Koller T, et al. Customized Corneal Cross-linking: One-Year Results. Am J Ophthalmol. 2016;166:14–21.CrossRefGoogle Scholar
  13. 13.
    Nordström M, Schiller M, Fredriksson A, et al. Refractive improvements and safety with topography-guided corneal crosslinking for keratoconus: 1-year results. Br J Ophthalmol. 2017;101:920–5.CrossRefGoogle Scholar
  14. 14.
    Cassagne M, Pierné K, Galiacy SD, et al. Customized Topography-Guided Corneal Collagen Cross-linking for Keratoconus. J Refract Surg. 2017;33:290–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Universitätsklinik für Augenheilkunde, Inselspital BernBernSwitzerland
  2. 2.Wellman Center for Photomedicine – Massachusetts General Hospital, Harvard Medical SchoolBostonUSA
  3. 3.Institut für Refraktive und Ophthalmo-Chirurgie (IROC)ZürichSwitzerland

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