Corneal cross-linking (CXL) continues to be one of the hottest topics in our field. Researchers from Greece wanted to assess the effect of CXL and of CXL combined with topography-guided photorefractive keratectomy (t-CXL) on self-reported quality of life (QOL) in stage 1 keratoconus patients. The paper, published in the journal Cornea, found that postoperatively, significant differences were detected in "mental health" and "dependency" for both the CXL and t-CXL groups. Furthermore, the t-CXL group demonstrated significant differences in the "near activities," "role limitations," and "driving." The researchers concluded that their results suggest that keratoconus exerts a significant impact on the patients' QOL, even in its early stages with normal best-spectacle-corrected visual acuity, and that both CXL and t-CXL seem to exert a beneficial impact on self-reported QOL, suggesting that they should be applied as soon as possible.  

While CXL has gained momentum regarding the stabilizing effects of corneal ectasia, it also is mentioned as a potential promising technique in the management of microbial keratitis, as Alan Kabat and Joseph Sowka point out in Review of Optometry. The first reports regarding this are from 2008, where it was described that the technique was used to destroy bacterial isolates of Staphylococcus in agar plates. In 2009, a series of 5 patients underwent CXL to treat infectious corneal melts that did not respond well to conventional treatment. The UV-A potentially can inhibit the growth of bacteria and fungi. At the same time, Joseph Shovlin in another article in Review of Optometry answers a question by a reader regarding a hypopyon that developed post-CXL. It is stated in this article that, "While infection is a rare complication of CXL, there have been a few reported cases of post-CXL infection in the literature," says Peter Hersh, director of the Cornea and Laser Eye Institute-Hersh Vision Group in Teaneck (USA). "Most are bacterial in origin, although herpes simplex keratitis and Acanthamoeba have been reported." Other than that, the article also refers to the potential therapeutic effects of CXL and points at the possible relationship, although rare, with corneal edema. "If the cornea is too thin, the interaction of riboflavin and the ultraviolet light potentially may damage the corneal endothelium leading to corneal swelling," it is stated in the article. Hence it seems wise to refrain from treating thin corneas.