Skip to main content
Log in

Visual recovery after corneal crosslinking for keratoconus: a 1-year follow-up study

  • Cornea
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript



To evaluate visual recovery and intraocular straylight in keratoconus patients 3 months and 1 year after corneal crosslinking (CXL)

Patients and Methods

Thirty-three eyes of 28 consecutive patients with mild to moderate keratoconus were included. The following were assessed at baseline, 3 months and 1 year after CXL: corrected distance visual acuity (CDVA), intraocular straylight, spherical equivalent (SE), keratometry (Kmax and K min (Diopters D and axis), the regularity index and pachymetry. Changes from baseline were calculated using mixed linear regression models.


The CDVA remained unchanged 3 months after CXL (-0.003 (95 % CI: -0.038 to 0.044); p = 0.880) and improved after 1 year (-0.042 (95 % CI: -0.078 to -0.007; p = 0.021)). The mean straylight value increased significantly by 0.27 (95 % CI: 0.18 to 0.35; p < 0.001) 3 months after CX and normalized to preoperative values after 1 year (0.06 (95 % CI: -0.03 to 0.14; p = 0.215)). SE improved from the mean preoperative value of -2.61 D (95 % CI: -3.83 to -1.39) by 1.95 (95 % CI: 1.03 to 2.86; p < 0.001) at 3 months and remained stable at the 1-year follow-up visit (2.17 (95 % CI: 1.21 to 3.12; p < 0.001)). Parameters of of keratometry changed only minimally. The regularity index remained almost unchanged at 3 months (2.45 (95 % CI: -4.97 to 9.88; p = 0.503)) and decreased by 6.97 (95 % CI: -14.08 to 0.14; p = 0.054). Pachymetry decreased by 44.0 μm (95 % CI: 56.1 to 31.9; p < 0.001) at 3 months and almost returned to preoperative values at 12 months (-11.3 μm (95 % CI: -27.9 to 5.3; p = 0.175)).


In accordance with the decrease in CDVA and patients’ complaints of disability due to glare, intraocular straylight increased 3 months after surgery. One year after CXL, there was an increase in CDVA due to an improved SE and regularity index, and intraocular straylight had normalized.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Caporossi A, Mazzotta C, Baiocchi S, Caporossi T (2010) Long-term results of riboflavin ultraviolet a corneal collagen cross-linking for keratoconus in Italy: the Siena eye cross study. Am J Ophthalmol 149:585–593

    Article  PubMed  CAS  Google Scholar 

  2. Davis LJ, Schechtman KB, Wilson BS, Rosenstiel CE, Riley CH, Libassi DP, Gundel RE, Rosenberg L, Gordon MO, Zadnik K, Collaborative Longitudinal Evaluation of Keratoconus Study G (2006) Longitudinal changes in visual acuity in keratoconus. Invest Ophthalmol Vis Sci 47:489–500

    Article  PubMed  Google Scholar 

  3. Hayes S, O’Brart DP, Lamdin LS, Doutch J, Samaras K, Marshall J, Meek KM (2008) Effect of complete epithelial debridement before riboflavin-ultraviolet-A corneal collagen crosslinking therapy. J Cataract Refract Surg 34:657–661

    Article  PubMed  Google Scholar 

  4. Raiskup-Wolf F, Hoyer A, Spoerl E, Pillunat LE (2008) Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: long-term results. J Cataract Refract Surg 34:796–801

    Article  PubMed  Google Scholar 

  5. Saffarian L, Khakshoor H, Zarei-Ghanavati M, Esmaily H (2010) Corneal Crosslinking for Keratoconus in Iranian Patients: Outcomes at 1 year following treatment. Middle East Afr J Ophthalmol 17:365–368

    Article  PubMed  Google Scholar 

  6. Vinciguerra P, Albe E, Trazza S, Rosetta P, Vinciguerra R, Seiler T, Epstein D (2009) Refractive, topographic, tomographic, and aberrometric analysis of keratoconic eyes undergoing corneal cross-linking. Ophthalmology 116:369–378

    Article  PubMed  Google Scholar 

  7. Wollensak G (2010) Corneal collagen crosslinking: New horizons. Expert Review of Ophthalmology 5:201–215

    Article  CAS  Google Scholar 

  8. Seiler T, Hafezi F (2006) Corneal cross-linking-induced stromal demarcation line. Cornea 25:1057–1059

    Article  PubMed  Google Scholar 

  9. Greenstein SA, Fry KL, Bhatt J, Hersh PS (2010) Natural history of corneal haze after collagen crosslinking for keratoconus and corneal ectasia: Scheimpflug and biomicroscopic analysis. J Cataract Refract Surg 36:2105–2114

    Article  PubMed  Google Scholar 

  10. Stojanovic A, Xiangjun Chen L (2011) Corneal Topography in the Wavefront Era A guide to clinical application SLACK Incorporated pages 126–130. ISBN-10: 1556429703

  11. Franssen L, Coppens JE, van den Berg TJ (2006) Compensation comparison method for assessment of retinal straylight. Invest Ophthalmol Vis Sci 47:768–776

    Article  PubMed  Google Scholar 

  12. Guber I, Bachmann LM, Guber J, Bochmann F, Lange AP, Thiel MA (2011) Reproducibility of straylight measurement by C-Quant for assessment of retinal straylight using the compensation comparison method. Graefes Arch Clin Exp Ophthalmol 249:1367–1371

    Article  PubMed  Google Scholar 

  13. Wollensak G, Spoerl E, Wilsch M, Seiler T (2004) Keratocyte apoptosis after corneal collagen cross-linking using riboflavin/UVA treatment. Cornea 23:43–49

    Article  PubMed  Google Scholar 

  14. Caporossi A, Baiocchi S, Mazzotta C, Traversi C, Caporossi T (2006) Parasurgical therapy for keratoconus by riboflavin-ultraviolet type A rays induced cross-linking of corneal collagen: preliminary refractive results in an Italian study. J Cataract Refract Surg 32:837–845

    Article  PubMed  Google Scholar 

  15. Mazzotta C, Balestrazzi A, Baiocchi S, Traversi C, Caporossi A (2007) Stromal haze after combined riboflavin-UVA corneal collagen cross-linking in keratoconus: in vivo confocal microscopic evaluation. Clin Experiment Ophthalmol 35:580–582

    Article  PubMed  Google Scholar 

  16. Meek KM, Tuft SJ, Huang Y, Gill PS, Hayes S, Newton RH, Bron AJ (2005) Changes in collagen orientation and distribution in keratoconus corneas. Invest Ophthalmol Vis Sci 46:1948–1956

    Article  PubMed  Google Scholar 

  17. Wollensak G (2006) Crosslinking treatment of progressive keratoconus: new hope. Curr Opin Ophthalmol 17:356–360

    Article  PubMed  Google Scholar 

  18. Elliott DB, Bullimore MA (1993) Assessing the reliability, discriminative ability, and validity of disability glare tests. Invest Ophthalmol Vis Sci 34:108–119

    PubMed  CAS  Google Scholar 

  19. van den Berg TJ (1986) Importance of pathological intraocular light scatter for visual disability. Doc Ophthalmol 61:327–333

    Article  PubMed  Google Scholar 

  20. Vos JJ (1984) Disability glare-a state of the art report. Commission International de l’Eclairage Journal: 39–53

  21. El-Raggal TM (2009) Riboflavin-Ultraviolet A Corneal Cross-linking for Keratoconus. Middle East Afr J Ophthalmol 16:256–259

    PubMed  Google Scholar 

  22. Rabinowitz YS, McDonnell PJ (1989) Computer-assisted corneal topography in keratoconus. Refract Corneal Surg 5:400–408

    PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors have no financial interest in any aspect of this article.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Ivo Guber.

Additional information

Josef Guber and Ivo Guber contributed equally to the paper.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Guber, I., Guber, J., Kaufmann, C. et al. Visual recovery after corneal crosslinking for keratoconus: a 1-year follow-up study. Graefes Arch Clin Exp Ophthalmol 251, 803–807 (2013).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: