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Corneal cross-linking with topical ozone application: is it possible?

Poster Details

First Author: A.Dogan TURKEY

Co Author(s):    C. Gurdal   S. Caliskan   E. Onder   A. Isgoren           

Abstract Details


Conventional cornea cross-linking (CXL) is an oxygen dependent photochemical reaction that exerts its effect by oxygen radicals those are formed by interaction of riboflavin and UVA. Ozone is an unstable tri-oxygen molecule that spontaneously breaks-down to oxygen and free radicals. The present study aimed to investigate whether ozone can be used as an adjuvant to the crosslinking reaction, as an oxygen generator, or stand alone as a cross-linking agent in cornea.


Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey


Twelve New Zealand albino rabbits (6 months old male, 3-4 kg) were used. Mechanical epithelial debridement were performed for all right eyes and divided into three study groups as group 1 (accelerated riboflavin-UVA cornea cross-linking, 5,4 J/cm2), group 2 (topical ozone application for 2 minutes, 40 mcg/ml) and group 3 (topical ozone application followed with CXL). Left eyes were used as control and sham with 6 eyes for each. Pre- and postoperative in vivo Corvis measurements, ex-vivo OCT and corneal confocal images were taken.


The rabbits were sacrificed at postoperative 5th day. Epithelial healing was complete in all rabbits. Pre- and postoperative Corvis measurements were not significantly different within and between the groups. OCT images proved the presence of significant demarcation lines in both groups 1 and 2 with similar appearance. However, in group 3, whole thickness stromal brightness was observed with less marked demarcation lines. Corneal confocal imaging in groups 1 and 2 revealed extracellular hyperreflectivity which was limited to anterior stroma, however hyperreflectivity was present in whole thickness in group 3.


Topical ozone treatment yielded similar results as CXL where the combination resulted exaggerated findings. These preliminary results may give a hint for the potential therapeutic effects of ozone. Future experimental studies are needed to investigate the dose optimization, efficacy, safety and feasibility. Acknowledgment: Funded by TUBITAK grant (115S862)

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