Current status of corneal collagen cross-linking for keratoconus: a review

Over the past decade, corneal collagen cross-linking has become commonplace as a treatment option for individuals with progressive keratoconus. This is based on laboratory data suggesting that cross-linking using riboflavin and ultraviolet-A irradiation increases collagen diameter and the biomechanical strength of the treated cornea. Case series and limited randomised controlled trials support these findings with data demonstrating that cross-linking slows and possibly halts the progression of keratoconus. In some patients cross-linking results in an improvement in maximum corneal curvature, visual acuity, spherical equivalent and higher-order aberrations. The number of reported complications is small. More recently, variations in the treatment protocol have been described, although they have not yet been subject to comparative studies. While the published data indicate cross-linking is effective in modifying the natural history of keratoconus, the long-term impact of this treatment is still unknown. This paper reviews the theoretical basis, pre-clinical research and clinical results of corneal collagen cross-linking in keratoconus.