Repeated Corneal Cross-linking (CXL) in Keratoconus Progression After Primary Treatment: Updated Perspectives

ABSTRACT

Background: Corneal collagen cross-linking (CXL) has recently become the preferred practice in the management of progressive keratoconus and other corneal ectasias as it has been proven to be successful in halting progression of the disease with an excellent safety and efficacy profile. However, there is a known variation regarding the response to CXL, depending on several parameters related either to the treatment protocol, patient characteristics, or corneal biomechanical properties. In fact, continuing progression of keratoconus has been noted in some cases despite prior treatment with CXL.

Methods: The aim of this article is to provide an updated review of all published results on repeated-CXL, focusing on the indications and the efficacy of repeated treatment and highlighting possible explanations of progression after primary CXL. Conclusions: The diagnosis of primary treatment failure should always be made based on specific clinical and imaging criteria, with repeated and consistent measurements, in order to exclude pseudoprogression. In cases of confirmed progression, physicians need to decide whether repeating CXL could be an option to enhance corneal stability without any complications.

KEYWORDS:

• Corneal cross linking
• repeated treatment
• keratoconus
• progression after treatment

DISCLOSURE STATEMENT

The authors have no conflicts of interest to declare. No proprietary interest in any of the products mentioned in the study.

Additional information

Funding

No financial grants or funds were received in support of the study.