Comparative Efficacy and Safety of Conventional Dresden, Transepithelial, and Accelerated Corneal Collagen Cross-Linking Protocols for Progressive Keratoconus: A Systematic Review

Conventional epi-off CXL has the strongest evidence for durable keratometric stabilization and visual acuity preservation in progressive keratoconus. Accelerated protocols offer similar short-term efficacy with improved treatment efficiency, while enhanced transepithelial approaches may be appropriate for selected patients prioritizing reduced invasiveness and postoperative discomfort, with potential trade-offs in long-term durability.