Combined Corneal Cross-Linking Protocols Publisher



Khorraminejad M¹ ; Mohammadpour M² ; Raeesdana K³
Source: Keratoconus: Optical and Surgical Management Published:2024

Abstract

Corneal collagen cross-linking (CXL) has become an established treatment for halting the progression of keratoconus. While CXL alone aims to strengthen the cornea, recent advances have combined CXL with additional refractive, topographic, or surface ablation procedures to provide comprehensive keratoconus management.123456781–8 This chapter discusses several combined CXL protocols that have been developed to not only arrest ectasia progression but also improve visual outcomes. The combined procedures described aim to optimize refractive correction, reduce irregular astigmatism, and stabilize the anterior corneal surface topography. Some protocols also aim to stabilize milder cases of keratoconus and potentially reduce the risk of future ectasia in high-risk refractive surgery patients. The chapter reviews several notable combined CXL protocols including the prophylactic CXL protocol, Cretan protocol, Tehran protocol, Athens protocol, modified Athens protocol, and Tel Aviv protocol. Each protocol is examined in detail, outlining the surgical techniques, reported outcomes, conclusions, and limitations. By combining CXL with other vision-improving and -stabilizing treatments, these combined protocols offer comprehensive keratoconus and keratectasia management. However, outcomes can vary depending on patient factors and each protocol may have specific limitations. This chapter provides an overview of established combined CXL approaches and their role in optimizing patient outcomes in refractive surgery and ectasia management. © 2025 selection and editorial matter, Mehrdad Mohammadpour and Masoud Khorrami-Nejad; individual chapters, the contributors.