Customized Corneal Cross-Linking

A Comparison Between Cross-Linking Protocols in Patients With Progressive Keratoconus: A Review

“…Therefore, KC should be suspected in patients with significant irregular astigmatism that is unstable and rapidly increasing. In advanced cases, the cone-shaped protrusion can be visible on a slit lamp as progressive corneal thinning and distortion have occurred [ 7 ].…”

“…Multiple diagnostic modalities to aid in the diagnosis of KC have been developed over the last decades, including corneal topography and tomography, KC indices, the Belin Ambrosio Enhanced Ectasia Display, Holladay six-map display, corneal pachymetry, automated screening program, and corneal biomechanics [ 7 ].…”

“…Recent studies proposed that the biomechanical modification in KC is focal rather than a uniform generalized weakening of the cornea, creating a cycle of increased strain, stress redistribution, and subsequent focal steepening and thinning. This proposed theory serves as the base of the novel technique of customized corneal cross-linking (X-CXL), which selectively uses more energy in weaker areas of the cornea and leaves the stronger areas with little to no energy used [ 7 ]. X-CXL is a general term that includes multiple novel techniques, including accelerated topography-guided CXL, accelerated pachymetry-guided CXL, and accelerated CXL-Plus (a combination of CXL and refractive surgical techniques) [ 7 ].…”

“…This proposed theory serves as the base of the novel technique of customized corneal cross-linking (X-CXL), which selectively uses more energy in weaker areas of the cornea and leaves the stronger areas with little to no energy used [ 7 ]. X-CXL is a general term that includes multiple novel techniques, including accelerated topography-guided CXL, accelerated pachymetry-guided CXL, and accelerated CXL-Plus (a combination of CXL and refractive surgical techniques) [ 7 ]. For this review, we will focus on accelerated topography-guided CXL.…”