Is corneal cross-linking (CXL) a treatment for keratoconus?

From the Guidelines

Corneal cross-linking (CXL) is a highly recommended treatment for keratoconus, as it has been shown to halt the progression of the disease and improve vision. The standard Dresden protocol, which involves removing the epithelium, applying riboflavin drops, and exposing the eye to UVA light, has been proven to be effective in stopping the deterioration and progression of keratoconus 1. This procedure works by creating new bonds between collagen fibers in the cornea, thereby strengthening the corneal structure and preventing further thinning and bulging.

Key Benefits of CXL for Keratoconus

• Halts the progression of keratoconus, preserving vision and potentially avoiding the need for corneal transplantation 1
• Improves corrected distance visual acuity compared to sham-control eyes 1
• Reduces the mean maximum keratometry value, indicating a decrease in corneal curvature 1
• Effective in pediatric patients, where keratoconus can present at an advanced stage and progress more aggressively than in adult counterparts 1

Procedure and Aftercare

• The procedure is typically performed on an outpatient basis under topical anesthesia
• Patients usually need to use antibiotic and anti-inflammatory eye drops for 1-2 weeks and may wear a bandage contact lens for several days while the epithelium heals
• A transient reduction in the endothelial cell count has been noted, but this typically returns to normal by 6 months 1

Long-term Safety and Efficacy

• Long-term studies confirm that standard CXL stops the deterioration and progression of keratoconus 1
• Meta-analysis of 75 publications with greater than 36 months follow-up shows improvement in uncorrected vision and a late reduction in keratometry values 1
• The procedure has a high safety profile, with no significant long-term complications reported 1

From the Research

Corneal Cross-Linking for Keratoconus

• Corneal cross-linking (CXL) is a treatment option for progressive keratoconus, as it has been shown to arrest the progression of the disease and improve visual, keratometric, and topographic parameters 2, 3, 4.
• The standard Dresden protocol, which uses riboflavin and ultraviolet A (UVA) light, is considered the gold standard for CXL treatment of progressive keratoconus 2.
• CXL has been shown to be effective in treating progressive keratoconus, with long-term stabilization of the condition and improvement in visual acuity, as demonstrated in a 10-year study 5.
• The procedure is not currently approved for stable keratoconus, and the optimal stromal riboflavin dosage for CXL is still undetermined 2, 3.
• Newer protocols, such as accelerated and transepithelial CXL, are being developed and researched, with the goal of improving safety and efficacy 6, 4.

Indications and Contraindications

• CXL is indicated for progressive keratoconus, as well as other corneal ectasias and diseases, such as infectious keratitis 2, 6.
• The procedure is contraindicated in patients with certain conditions, such as corneal thickness less than 400 μm, and requires careful consideration of the risks and benefits in each individual case 2.

Safety and Efficacy

• CXL has been shown to be safe and effective in treating progressive keratoconus, with rare sight-threatening complications and significant improvements in visual and keratometric parameters 2, 3, 5.
• The procedure has a good safety profile, with no significant changes in endothelial cell count or other adverse effects reported in long-term studies 5.