The idea of using Corneal Collagen Crosslinking
with Riboflavin (CxL
) to affix the Lasik flap to the underlying stroma is one of theoretical speculation at this point, and I like to say that nothing screws up a perfectly good theory faster than reality.
The theory behind CxL is that the natural bonds that hold cells close to one another can be strengthened by the application of UV light of a wavelength of 370 nm for 30 minutes. The mechanics behind CxL are really not fully proven. There is a stiffing of the cornea with CxL, but I have not seen anything that affirms the stiffening is because CxL caused the bonds between cells to strengthen and thereby make the cornea more stiff; because the primary cells are aged quickly due to the UV light and the cells themselves become stiff - not the bonds between them; or some other healing response not yet clarified.
For CxL to work across a Lasik flap interface one must assume that there is some crosslinking in the first place. So far, CxL has only been shown to provide improvement in existing crosslinked cells, not creating crosslinking in cells that have been severed. That would be a big jump, excuse the pun.
Additionally, the Lasik flap interface is no longer the same as the untouched area of the cornea. It is a healed wound. Even with normal healing, the center of the Lasik flap contributes very little to the structural integrity of the cornea, less than about 3% of normal. This indicates strongly that the corneal cells in the center of the corena are not affixing to each other in the manner by which they were aligned and affixed before the flap.
BTW: The periphery of the corneal flap heals quite solidly. Think of the Lasik flap as a Tupperware lid held firmly at the edges but not firmly in the center. You may want to learn more about Lasik flap healing
At this point in development CxL seems to be an answer for which the correct question has not been found. It is great that the wise are coming up with all these different potential applications, but healthcare has a long history of expecting too much of the new.
Don’t be surprised the theory behind the concept is not proven, yet CxL is being performed in many countries successfully and is going through an FDA clinical trail in the US. We don’t know what electricity is, but that does not mean we need to be in the dark.
One doctor in the US is performing a crosslinking technique that is not part of the FDA clinical trial. He calls it C3R