Abstract
One sign used to characterize the level of penetration achieved with any type of protocol of corneal collagen crosslinking (CXL) in the clinical practice is the corneal stromal demarcation line. This sign can be detected using confocal microscopy and anterior segment optical coherence tomography (AS-OCT) (Fig. 12.1), and with less accuracy with Scheimpflug imaging. There are several studies reporting lower depths for the demarcation line after accelerated (A-CXL) and iontophoresis-assisted transepithelial crosslinking (I-CXL) compared to that observed after conventional epi-off crosslinking (C-CXL). However, there are no studies showing the relationship between the depth of this line and the real changes induced in the mechanical properties of the cornea with the treatment. Indeed, it has been demonstrated that there are no significant correlations of the demarcation line depth after C-CXL, A-CXL and I-CXL with the change achieved postoperatively (6 months) in corrected distance visual acuity, maximum keratometry and central corneal thickness. To this date, with the available scientific evidence, it cannot be stated that a lower depth of the demarcation line is associated to a lower effect of the CXL treatment or a higher potential of corneal instability in the future. For this reason, more studies are still needed on this issue.
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Piñero Llorens, D.P. (2019). Demarcation Line in Corneal Collagen Crosslinking and Its Clinical and Topographic Significance. In: Barbara, A. (eds) Controversies in the Management of Keratoconus . Springer, Cham. https://doi.org/10.1007/978-3-319-98032-4_12
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