Corneal stromal demarcation line after collagen cross-linking in corneal ectatic diseases: a review of the literature

Figures & data

Table 1 Comparative findings of corneal stromal DL depth after CXL

Study	Patients (N)	CXL protocol	DL depth	Detection modality	Time of DL detection
Seiler and Hafezi^Citation47	16	Conventional	300 µm	Confocal microscopy	2 weeks
Doors et al^Citation51	28	Conventional	313 µm	AS-OCT	1 month
Yam et al^Citation49	40	Conventional	281 µm	AS-OCT	6 months
Filippello et al^Citation61	20	Transepithelial	100 µm	AS-OCT	2 weeks
Kymionis et al^Citation56	16	Conventional vs accelerated	351 µm; 288 µm	AS-OCT	1 month
Mazzotta et al^Citation59	20	Accelerated PL vs CL	215 µm PL; 160 µm CL	AS-OCT/confocal microscopy	1 month
Moramarco et al^Citation50	60	Accelerated PL vs CL	213 µm PL; 149 µm CL	AS-OCT	1 month
Bonnel et al^Citation64	12	Iontophoresis	247 µm	AS-OCT	1 month
Kymionis et al^Citation48	29	Conventional vs accelerated	342 µm; 313 µm	AS-OCT	1 month
Bikbova and Bikbov^Citation65	119	Conventional vs iontophoresis	292 µm; 172 µm	AS-OCT	2 weeks

Abbreviations: AS-OCT, anterior segment optical coherence tomography; CL, continuous light; CXL, collagen cross-linking; DL, demarcation line; PL, pulsed light.

Figure 1 Biomicroscopic image of keratoconus eye at slit lamp 6 months after epi-off standard corneal CXL.

Note: DL is visible in the middle of the cornea.
Abbreviations: CXL, collagen cross-linking; DL, demarcation line; epi-off, epithelium-off.

Figure 2 AS-OCT of keratoconus eye 6 months after epi-off corneal cross-linking radiating with UV-A at 3 mW/cm².

Note: DL is visible to a depth of 314 µm.
Abbreviations: AS-OCT, anterior segment optical coherence tomography; DL, demarcation line; epi-off, epithelium-off; UV-A, ultraviolet A.

Figure 3 AS-OCT of keratoconus eye 6 months after accelerated epi-off corneal cross-linking radiating with UV-A at 10 mW/cm².

Note: DL is visible to a depth of 290 µm.
Abbreviations: AS-OCT, anterior segment optical coherence tomography; DL, demarcation line; epi-off, epithelium-off; UV-A, ultraviolet A.

Figure 4 AS-OCT of keratoconus eye 6 months after epi-on corneal cross-linking radiating with UV-A at 3 mW/cm².

Note: DL is fairly visible to a depth of 180 µm.
Abbreviations: AS-OCT, anterior segment optical coherence tomography; DL, demarcation line; epi-on, epithelium-on; UV-A, ultraviolet A.

Figure 5 AS-OCT of keratoconus eye 6 months after epi-on corneal cross-linking with iontophoresis imbibition radiating with UV-A at 10 mW/cm².

Note: DL is barely discernible to a depth of 280 µm.
Abbreviations: AS-OCT, anterior segment optical coherence tomography; DL, demarcation line; epi-on, epithelium-on; UV-A, ultraviolet A.

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