The February 2023 issue of DGII aktuell, the official publication of the Deutschsprachige Gesellschaft für Intraokularlinsen-Implantation, interventionelle und refraktive Chirurgie (DGII), includes an overview article on the current state of corneal cross-linking (CXL). Authored by Prof. Farhad Hafezi, MD, PhD, FARVO, Medical Director of the ELZA Institute, the article provides a concise, practice-oriented summary of how CXL has evolved beyond a single standardized procedure into a spectrum of individualized treatment strategies.
Originally introduced as a method to halt progression in keratoconus using the epithelium-off Dresden protocol, CXL has undergone substantial refinement over the past decade. As outlined in DGII aktuell, several alternative protocols are now clinically established, including accelerated CXL, high-fluence CXL, and epithelium-on (epi-on) approaches. These developments have been driven by improved understanding of the photochemical mechanisms underlying cross-linking, as well as advances in device technology and riboflavin formulations.
The article also highlights the expansion of CXL indications beyond corneal ectasia. One such indication is PACK-CXL (photoactivated chromophore for keratitis–corneal cross-linking), which applies cross-linking principles to infectious keratitis with the aim of increasing stromal resistance to enzymatic degradation and supporting infection control as an adjunct to antimicrobial therapy. In addition, Prof. Hafezi discusses the role of CXL combined with wavefront-guided photorefractive keratectomy to improve irregular astigmatism in selected keratoconus cases.
A central theme of the DGII aktuell overview is the shift away from a “one-size-fits-all” approach. Rather than applying a uniform protocol to every patient, modern CXL increasingly relies on individualized treatment selection based on corneal thickness, disease stage, and therapeutic goal. This evolution is reflected in the overview table included in the article, which summarizes CE-certified cross-linking devices and riboflavin solutions currently available in Germany.
By situating CXL within a broader framework of personalized corneal care, the DGII aktuell article underscores how cross-linking has become a flexible therapeutic platform rather than a single intervention. The contribution by Prof. Hafezi reflects ongoing efforts to integrate biomechanical stabilization, safety considerations, and visual rehabilitation into coherent, evidence-based treatment pathways.
