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Updated: Mar 21, 2026
Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Tear Function and Ocular Surface Alterations After Accelerated Corneal Collagen Cross-Linking in Progressive
Emine Kalkan Akçay1, Aydan Kilicarslan, Betul Seher Uysal
1Department of Ophthalmology (E.K.A., A.K., B.S.U., H.A., N.C.), Ankara Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey; and Department of Ophthalmology (G.H., P.K.), Ulucanlar Eye Training and Research Hospital, Ankara, Turkey.
Accelerated corneal collagen cross-linking (A-CXL) in progressive keratoconus (KC) patients showed no adverse effects on ocular surface and tear function after 3 months. Conjunctival impression cytology revealed metaplastic changes and reduced goblet cells, but did not impact tear film breakup time.
Area of Science:
- Ophthalmology
- Corneal Science
- Ocular Surface Disease
Background:
- Progressive keratoconus (KC) poses a risk to visual quality.
- Corneal collagen cross-linking (CXL) aims to halt KC progression.
- Accelerated CXL (A-CXL) is a modified treatment protocol.
Purpose of the Study:
- To evaluate ocular surface and tear film changes 3 months post-A-CXL in KC patients.
- To assess the safety and functional impact of A-CXL on the ocular surface.
Main Methods:
- Prospective study of 26 patients (33 eyes) with progressive KC.
- Ophthalmic examinations included OSDI, tear osmolarity, Schirmer test, TBUT, ocular surface staining (RB, Fl), and conjunctival impression cytology (IC).
- Evaluations performed at baseline and 3 months post-A-CXL using Nelson's grading system for IC.
Main Results:
- No significant changes in tear osmolarity, TBUT, Schirmer test, OSDI scores, or Fl/RB staining post-A-CXL.
- A significant increase in superior and temporal conjunctival IC grading was observed.
- IC analysis indicated metaplastic changes and decreased goblet cell density.
Conclusions:
- A-CXL did not adversely affect tear film parameters or ocular surface health in KC patients at 3 months.
- Conjunctival metaplasia and reduced goblet cells post-A-CXL may be linked to ultraviolet-A toxicity.
- Despite cellular changes, A-CXL appears safe for ocular surface and tear function, crucial for visual quality.
