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Updated: May 11, 2026
Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Early confocal microscopy findings after cross-linking treatment
M Ramírez1, E Hernández-Quintela, R Naranjo-Tackman
1Servicio de Córnea y Cirugía Refractiva, Asociación para Evitar la Ceguera en México, Hospital Luis Sánchez Bulnes, Universidad Nacional Autónoma de México, Mexico City, Mexico. mramirezf@medicasur.org.mx
Objective:
To determine the effects of in vivo cross-linking treatment of the cornea.
Methods:
Eighteen eyes of eighteen keratoconus patients underwent cross-linking treatment using a 0.1% riboflavin solution and ultraviolet A radiation at 370 nm at 3 mW/cm² for 30 minutes. In vivo confocal microscopy was performed before, and at 1 week and 1 month after treatment.
Results:
At 1 week after treatment, keratocyte activation and collagen fiber organization showed as hyper-reflective structures and were observed from the first sub-epithelial image to a corneal stromal depth of 275.1 ± 85.9 μm. At 1 month after treatment, activated keratocytes and fiber organization were also observed from the first sub-epithelial image to a corneal stromal depth of 324.9 ± 66.0 μm. The deepest hyper-reflective structures at 1 month showed as thick, linear-shaped hyper-reflective structures.
Conclusion:
In vivo confocal microscopy in humans showed corneal stromal changes at 1 week and 1 month after cross-linking treatment, in some cases at depths in excess of 300 μm.
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