Use of corneal cross-linking beyond keratoconus: a systemic literature review

Richard P.C. Manns, Asaf Achiron, Boris Knyazer, Omar Elhaddad, Kieran Darcy, Tal Yahalomi, Derek Tole, Venkata S. Avadhanam*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Purpose: The success of corneal collagen cross-linking in altering keratoconus’ clinical course has driven a search for further uses of this procedure. This literature review aims to analyze the scientific evidence available for the benefit of cross-linking in the management of ophthalmic diseases other than progressive keratoconus or ectasia induced by corneal refractive procedures. Methods: A systemic literature review. Results: We reviewed 97 studies. We found that collagen cross-linking can limit the progression of several other corneal ectasias, thus reducing and limiting the need for keratoplasty. Collagen cross-linking also can reduce the refractive power of the cornea and can be considered for a moderate degree of bacterial keratitis or when the organism is unidentified, which is refractive to antibiotics alone. However, the comparative rarity of these procedures has limited the extent of evidence. In fungal, Acanthamoeba, and herpes virus keratitis, the evidence is inconclusive of the safety and efficacy of cross-linking. Conclusion: Current clinical data is limited, and laboratory data has not fully correlated with published clinical data.

Original languageEnglish
Pages (from-to)2435-2453
Number of pages19
JournalGraefe's Archive for Clinical and Experimental Ophthalmology
Issue number9
StatePublished - Sep 2023


  • Cross-link
  • Ectasia
  • Keratoconus
  • Review


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