Biologically Assisted Corneal Cross-Linking: Beyond Biomechanics
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR363 | Type: Free paper | DOI: 10.82333/gk2h-fx44
Authors: A/Prof. Mehdi Khamaily* 1
1OPHTHALMOLOGY,MOHAMMED 6 INTERNATIONAL UNIVERSITY HOSPITAL,CASABLANCA ,Morocco
Purpose
Biologically Assisted Corneal Cross-Linking: Beyond Biomechanics
From Structural Reinforcement to Biological Healing
Setting
to evaluate the clinical and tomographic outcomes of biologically assisted corneal cross-linking (BACXL) using dehydrated amniotic membrane in patients undergoing sequential bilateral corneal cross-linking.
Methods
this prospective interventional study included 30 patients (60 eyes) with progressive corneal ectasia who underwent bilateral corneal cross-linking performed sequentially, with a time interval between eyes. Standard epithelium-off corneal cross-linking was performed using riboflavin and UVA irradiation. At the end of the procedure, a dehydrated amniotic membrane was applied to the corneal surface and covered with a therapeutic soft contact lens. Patients were followed for 6 months. Outcome measures included postoperative pain, time to complete re-epithelialization, corneal clarity, stromal haze grading, uncorrected and corrected visual acuity, keratometric values (Kmax), pachymetry, and postoperative complications.
Results
ll treated eyes completed the follow-up period without intraoperative complications. Mean epithelial healing time was rapid, with complete re-epithelialization achieved within 3–5 days in most eyes. Postoperative pain was mild and transient. At 6 months, corneal transparency was preserved in all cases, with minimal or no stromal haze. Mean Kmax values showed stabilization or slight regression, and no progression of corneal ectasia was observed. No cases of infectious keratitis, persistent epithelial defect, corneal melting, or neovascularization were reported.
Conclusions
Biologically assisted corneal cross-linking combining standard CXL with dehydrated amniotic membrane is a safe and effective strategy in sequential bilateral treatment. By integrating biomechanical stabilization with biological modulation of healing and inflammation, this approach supports a shift from purely mechanical reinforcement toward true biological healing in corneal cross-linking.