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Indian J Ophthalmol. 2019 Jan;67(1):8-15. doi: 10.4103/ijo.IJO_1403_18.

Current concepts in crosslinking thin corneas.

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Cornea, Cataract and Refractive Services, Centre for Sight Hospital, New Delhi, India.
ELZA Institute, Dietikon/Zurich; Laboratory for Ocular Cell Biology, University of Zurich, Zurich, Switzerland; University of Southern California, Roski Eye Institute, Los Angeles, CA, USA; Department of Ophthalmology, University of Wenzhou, Wenzhou, China.
Athens Medical School, University of Athens, Athens, Greece; Jules Gonin Eye Hospital, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
Ophthalmic Personalized treatment and imaging cluster (OPTIC), Department of Information Technology and Electrical Engineering Swiss Federal Institute of Technology Zurich (ETHZ), Switzerland.
Centre for Sight Hospital, Vadodara, India.
Department of Cornea and Refractive Surgery, Sankara Nethralaya, Chennai, India.


Corneal cross-linking (CXL), introduced by Wollensak et al. in 2003, is a minimally invasive procedure to halt the progression of keratoconus. Conventional CXL is recommended in eyes with corneal thickness of at least 400 microns after de-epithelialization to prevent endothelial toxicity. However, most of the keratoconic corneas requiring CXL may not fulfill this preoperative inclusion criterion. Moderate-to-advanced cases are often found to have a pachymetry less than this threshold. There are various modifications to the conventional method to circumvent this issue of CXL thin corneas while avoiding the possible complications. This review is an update on the modifications of conventional CXL for thin corneas.


Cross-linking; keratoconus; thin cornea

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