Cross-Linking in ectasia after LASIK/PRK/SMILE

Ectasia developing after LASIK, PRK, or SMILE – often described as “man-made” keratoconus – belongs to the family of corneal ectasias alongside keratoconus and pellucid marginal degeneration (PMD). Before 2007, this complication was one of the most devastating outcomes of refractive surgery, with corneal transplantation as the only available treatment. This invasive procedure required general anesthesia and carried significant risks, including graft rejection and prolonged recovery times.

In 2007, Prof. Farhad Hafezi and colleagues published the world’s first successful clinical study demonstrating the efficacy of corneal collagen cross-linking (CXL) to halt the progression of post-LASIK ectasia. This seminal paper, cited over 600 times, laid the foundation for CXL to become the global gold standard treatment for this previously untreatable condition.

Thanks to ELZA’s pioneering work, patients worldwide now benefit from a less invasive, safer option that stabilizes corneal structure, dramatically reducing the need for transplantation and improving quality of life. Moreover, this initial breakthrough sparked a wave of research globally, inspiring numerous groups, including ours, to refine and expand CXL protocols for post-refractive ectasia, cementing its central role in contemporary corneal therapy.

Until 2007, the only option for treating ectasia after LASIK and PRK was corneal transplantation (keratoplasty). This operation is serious (it requires general anaesthesia) and carries the risk of rejection.

However, in 2007, the world saw the very first patients with post-LASIK ectasia successfully treated with CXL. Since then, CXL has become the global gold standard for the treatment of this disorder.