A Review of Keratoconus Cross-Linking Treatment Methods

AI Generated Summary*

Literature review surveying corneal collagen cross-linking (CXL) techniques for progressive keratoconus, drawing on 75 publications spanning 1998 to 2023. The Dresden protocol (riboflavin plus 3 mW/cm2 UV-A for 30 minutes) serves as the benchmark, with 10-year data showing keratometry falling from 61.5 D to 55.3 D. Modifications covered include accelerated, epithelium-on, pulsed, iontophoresis-assisted, diluted alcohol plus iontophoresis, slit-lamp and combined protocols. Evidence suggests transepithelial approaches are associated with fewer complications (2% versus 4%) but halt progression less reliably, while accelerated protocols generally leave shallower demarcation lines; a 613-eye series and two meta-analyses found greater flattening with conventional epithelium-off treatment. The central argument is that CXL is evolving toward faster, safer, more customized care, though longer follow-up is needed.

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