Long-term effects of epithelium-off corneal cross-linking in keratoconus therapy

Background: We report a well-documented cases of progressive corneal flattening and visual improvement after epithelium-off corneal cross-linking (epioff CXL) for keratoconus with long-term follow-up.Case report: Two young men reported with deterioration of vision and diagnosed keratoconus few months earlier. Corneal tomography confirmed the previous diagnosis. Considering the age of the patients it was decided to perform epi-off CXL in both eyes. Based on several years of observation, no progression of the disease has been observed. In both cases, good visual acuity is maintained, what is unexpected the reduction in the maximum keratometry reading is still flattening also corneal thickness is reduced.Conclusion: Continuous long-term flattening and corneal thinning after corneal cross-linking seems to be unpredictability in some cases. Our report highlights the importance of long-term evaluation of crosslinking techniques.