Our results suggest that KC exerts a significant impact on KC patients' QOL, even in its early stages with normal best-spectacle-corrected visual acuity. Moreover, both CXL and CXL combined with t-PRK seem to exert a beneficial impact on self-reported QOL, suggesting that they should be applied as soon as possible.

ORA parameters demonstrate significant differences between KC and non-KC eyes. Both CH and CRF present significant correlations with visual acuity and corneal parameters. CXL exerts a non-significant impact on ORA measurements.

CXL should be considered as a potential adjuvant therapeutic tool in patients with combined bullous keratopathy and infectious keratitis, who are resistant to traditional topical therapy.

Corneal collagen cross-linking (CXL) using riboflavin and ultraviolet-A irradiation is a common method of tissue stabilization and has been developed primarily to address the need of treating keratoconus. CXL's promising results on keratoconus indicated that it might be effective in other corneal diseases as well. This new treatment promises a slowing effect on the progression of these diseases and its initial results show that it is safe and reasonably curative. The purpose of this review is to critically evaluate this treatment, to explore its benefits, to highlight its limitations in terms of efficacy and long-term safety and finally to identify areas for future research in this topic with a significant potential to change the way we treat our patients. In addition, in this unbiased review we try to bring together all the scientific information from both laboratory and clinical trials that have been conducted during recent years and to review the most recent publications regarding the therapeutic indications of CXL.