Water Soluble Tetrazolium Salt-11 as an Alternative to Riboflavin for Corneal Collagen Cross-linking for the Treatment of Keratoconus

Abstract

Corneal collagen cross-linking (CXL) is effective in halting progression of keratoconus, nevertheless, it is not without its drawbacks. Water soluble tetrazolium salt (WST) that generates superoxide and hydroxyl radicals following near-infrared (NIR) illumination result in a three-fold increase in corneal stiffness. This seems to be comparable to riboflavin/ultraviolet A (UVA)-mediated cross-linking. Moreover, WST is able to pene­trate faster and deep into the cornea while offering protection to endothelial cells and reducing corneal keratocyte loss in the posterior cornea. Early studies suggest good safety and efficacy profile when tested on rabbit eyes in vivo and ex vivo .