Corneal Collagen Cross-Linking Outcomes: Review

Mirko R Jankov II*, 1, Vesna Jovanovic 1, Sladjana Delevic 2, Efekan Coskunseven 2
1 LaserFocus – Centre for Eye Microsurgery, Belgrade, Serbia
2 Oculus – Specialized Hospital for Ophthalmology, Belgrade, Serbia
3 Dunya Eye Hospital, Istanbul, Turkey

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© Jankov et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the LaserFocus – Centre for Eye Microsurgery, 25, Cara Nikolaja II str, 11000 Belgrade, Serbia; Tel/Fax: +381 11 344 6626; E-mail:


Keratoconus is a condition characterized by biomechanical instability of the cornea, presenting in a progressive, asymmetric and bilateral way. Corneal collagen cross-linking with riboflavin and UVA (CXL) is a new technique of corneal tissue strengthening that combines the use of riboflavin as a photo sensitizer and UVA irradiation. The studies showed that CXL was effective in halting the progression of keratoconus over a period of up to four years. The published studies also revealed a reduction of max K readings by more than 2 D, while the postoperative SEQ was reduced by an average of more than 1 D, and refractive cylinder decreased by about 1 D. No eyes lost any line of BCDVA. Moreover, there was no significant decrease in endothelial cell density. It was also found that CXL treatment was effective with reducing corneal and total wavefront aberrations. Corneal cross-linking has also led to an arrest and/or even a partial reversal of keratectasia in the treatment of iatrogenic ectasia after excimer laser ablation. A primary intervention such as CXL should be considered to potentially increase the biomechanical stability of the corneal tissue and postpone the need of lamellar or penetrating keratoplasty.

Keywords: Cornea, collagen, keratoconus, riboflavin, ultraviolet radiation.