Sehrish Khan, Aunaza Maqbool, Alizay Gohar, Usman Arshad, Rabia Sharif, Sohail Zia


Background: Corneal collagen cross-linking (CXL) is a minimally invasive technique that halts the advancement of keratoconus. The objective of our study was to determine mean change in endothelial cell density in patients with advancing keratoconus through specular microscopy who had undergone collagen cross-linking (CXL)

Materials & Methods: A quasi experimental study was done at the Cornea Clinic, Al-Shifa Trust Eye Hospital, Rawalpindi from June 2020 to January 2021. There were 42 patients that participated in the study. Patients were advised specular microscopy (SP.2000P, TOPCON, USA) before the CXL and endothelial cell density was recorded in each case. On follow up after 1 and 4 months of this procedure, specular microscopy was again advised and endothelial cell density was recorded again.

Results: Patients ranged between 10-30 years of age with mean age of 17.8±4.2 year. In our study 26 (61.9%) were male patients while 16 of them (38.1%) were female. Stratification with regard to age and gender was carried out. Mean change in endothelial cell density before CXL and after 1 month was found statistically significant while mean change in endothelial cell density before CXL and after 4 months of CXL was found statistically non-significant.

Conclusion: In conclusion, results of this study indicate that a statistically significant decrease (p<0.005) was observed in endothelial cell density as shown by specular microscopy in patients with progressive Keratoconus after 1 month of CXL, however it is noteworthy that after 4 months of the procedure the endothelial cell count returned to its initial level. There were minimal variations in results found between male and female patients.


Keratoconus; Cornea; Cross-linking; Corneal collagen Cross-linking; Keratoectasia.

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