In Vivo Early Corneal Biomechanical Changes After Corneal Cross-linking in Patients With Progressive Keratoconus

J Refract Surg. 2017 Dec 1;33(12):840-846. doi: 10.3928/1081597X-20170922-02.


Purpose: To report early corneal biomechanical changes after corneal cross-linking (CXL) in patients with keratoconus.

Methods: Thirty-four eyes of 34 patients undergoing CXL for progressive keratoconus were included in this prospective clinical study. Dynamic corneal response (DCR) parameters obtained with the Corvis ST (OCULUS Optikgeräte GmbH; Wetzlar, Germany) were assessed at baseline (day of CXL) and after 1 month of follow-up; conversely, corneal tomography with the Pentacam (OCULUS Optikgeräte GmbH) was assessed at baseline and at 1, 3, and 6 months after CXL.

Results: At the last follow-up visit (123.7 ± 69.6 days), all morphological parameters including steepest point (Kmax) and thinnest corneal thickness (ThCT) indicated stabilization of keratoconus (P > .05). Comparative analyses showed a rise of corneal stiffness demonstrated by a significant increase of Stiffness Parameter A1 (SP-A1) and Highest Concavity (SP-HC) and a significant decrease of Inverse Concave Radius (1/R) and Deformation Amplitude Ratio (DA Ratio) (P < .05). There was a significant correlation between the preoperative keratoconus characteristics (Kmax, Belin/Ambrósio final D value [BAD-D], and ThCT) and the DCR parameters (P < .05). Kmax and BAD-D showed a significant positive correlation with DA Ratio, Deflection Amplitude (DefA), and 1/R and a significant negative correlation with SPA1 and SP-HC. ThCT showed a significant positive correlation with SP-A1 and SP-HC and a significant negative correlation with DA Ratio, DefA, and 1/R.

Conclusions: This study suggests that the new DCR parameters of the Corvis ST are able to detect early changes in biomechanics following CXL and those that are measurable before corneal shape modifications take place. Based on these results, the authors suggest the use of these metrics to assess the early efficacy of cross-linking. [J Refract Surg. 2017;33(12):840-846.].

MeSH terms

  • Adult
  • Biomechanical Phenomena
  • Collagen / metabolism
  • Cornea / physiology*
  • Corneal Stroma / metabolism
  • Corneal Topography
  • Cross-Linking Reagents*
  • Elasticity / physiology*
  • Female
  • Humans
  • Keratoconus / drug therapy*
  • Keratoconus / metabolism
  • Keratoconus / physiopathology
  • Male
  • Photochemotherapy*
  • Photosensitizing Agents / therapeutic use*
  • Prospective Studies
  • Riboflavin / therapeutic use*
  • Ultraviolet Rays
  • Visual Acuity / physiology


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