Corneal crosslinking in keratoconus management

Since two decades, corneal crosslinking (CXL) has been proposed as the sole therapeutic option to halt progression of keratoconus or other ectatic diseases. CXL aims at stiffening the cornea using a combination of ultraviolet-A light and a chromophore (vitamin B2, riboflavin), and has been proposed in various indications, from progressive ectatic diseases to corneal infection. Despite being in clinical use for many years, many controversies and discrepancies exist towards CXL procedure and its exact role is still under debate. We report an up-to-date review of the state of the art of CXL and describe the basic principles, the different existing CXL techniques reporting basic and clinical evidence, as well as the new perspectives and the possible future developments of the procedure.