The corneal collagen cross-linking (CXL) has been described as a treatment option for the corneal ectatic disease for over a decade. Multiple studies have revealed that CXL has effects on slowing keratoconus (KC) progression. These results, combined with the low incidence of complications and adverse effects, have allowed an exponential increase in the implementation of CXL as a primary treatment for progressive KC, with quite favorable results, although long-term effect and more clear metrics for progression in KC are still a concern.
Standard corneal CXL technique includes total epithelium removal in around the central 7–9 mm in diameter, to increase riboflavin concentration in the corneal stroma: the epithelium- off (epi-off) technique . However, other alternatives have been used, including transepithelial riboflavin application: the epithelium-on (epi-on) techniques . Some…
