Corneal collagen crosslinking with riboflavin and ultraviolet-A light in progressive keratoconus: ten-year results

J Cataract Refract Surg. 2015 Jan;41(1):41-6. doi: 10.1016/j.jcrs.2014.09.033.


Purpose: To analyze the 10-year results of corneal collagen crosslinking (CXL) for keratoconus.

Setting: Department of Ophthalmology, University Hospital, Dresden, Germany.

Design: Retrospective interventional case series.

Methods: The study included eyes treated for progressive keratoconus from 2000 to 2004. Corneal collagen crosslinking was performed by applying riboflavin and ultraviolet-A. The corrected distance visual acuity (CDVA), corneal topography, and endothelial cell count (ECC) were recorded preoperatively and 10 years postoperatively.

Results: The study enrolled 24 patients (34 eyes). The mean age of the 18 men and 6 women was 28.4 years ± 7.3 (SD) and the mean follow-up, 131.9 ± 20.1 months. The mean apical keratometry (K) value was 61.5 diopters (D) preoperatively and 55.3 D 10 years postoperatively; the decrease was statistically significant (P<.001). The mean values for maximum K (53.2 D and 49.56 D, respectively) and minimum K (47.5 D and 45.5 D, respectively) were also significantly lower (P<.001). The preoperative and postoperative CDVA were statistically significantly different (P=.002). The mean CDVA improved by 0.14 logMAR over preoperatively; the change was statistically significant (P=.002). The ECC was unchanged.

Conclusions: Corneal CXL was effective in treating progressive keratoconus, achieving long-term stabilization of the condition. It was easy to perform, had a good safety profile, and reduced the need for corneal transplantation.

Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned.

MeSH terms

  • Adolescent
  • Adult
  • Collagen / metabolism*
  • Corneal Stroma / metabolism*
  • Cross-Linking Reagents*
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Keratoconus / drug therapy*
  • Keratoconus / metabolism
  • Keratoconus / physiopathology
  • Male
  • Photochemotherapy*
  • Photosensitizing Agents / adverse effects
  • Photosensitizing Agents / therapeutic use*
  • Retrospective Studies
  • Riboflavin / adverse effects
  • Riboflavin / therapeutic use*
  • Ultraviolet Rays
  • Visual Acuity / physiology
  • Young Adult


  • Cross-Linking Reagents
  • Photosensitizing Agents
  • Collagen
  • Riboflavin