title: Comparison of the findings of endothelial specular microscopy before and after corneal cross-linking.
abstract: BACKGROUND
  To report the long-term findings of corneal cross-linking (CXL) with riboflavin drops on the corneal endothelial cell.
  
  
  METHODS
  In this prospective non-randomized study, we aim to assess the long-term safety of CXL on the corneal endothelium for the treatment of progressive keratoconus, by endothelial specular microscopy. A total of 68 eyes of 42 keratoconus patients were selected. We checked the corneal thickness (with ultrasonic pachymetry), endothelial cell density, pleomorphism, and polymegathism (with specular microscopy) of the endothelial cells, before CXL and one year after this procedure.
  
  
  RESULTS
  The mean ± SD of the preoperative and postoperative corneal thicknesses were 470 ± 40 μm and 469.8 ± 42 μm, respectively (p-value = 0.591). The mean ± SD of the preoperative and postoperative endothelial cell densities were 2753 ± 230 cells/mm[2] and 2699 ± 210 cells/mm,[2] respectively (p-value = 0.004). We found reduction in the endothelial cell density after CXL, but this reduction was less significant in a corneal thickness of less than 400 μm (which was treated with hypo-osmolar riboflavin 0.1% drops) compared to the corneal thickness of more than 450 μm. We did not find any significant differences in the cell shapes (pleomorphism) (p-value = 0.517), but the cell sizes (polymegathism) were changed after the procedure (p-value = 0.021).
  
  
  CONCLUSIONS
  We found a significant decrease in endothelial corneal cell density after CXL, but this reduction was low; also the size of these cells increased after CXL. We believe that other parameters besides the corneal thickness may be the determinant factors for the changing of cell density and cell size in corneal endothelial cells.
authors: Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Hasan
authors: H
authors: Razmjoo
authors: Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Seyed Mohammad
authors: SM
authors: Ghoreishi
authors: Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Zahra
authors: Z
authors: Mohammadi
authors: Department of Ophthalmologist, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Hasan
authors: H
authors: Salam
authors: Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Kobra
authors: K
authors: Nasrollahi
authors: Department of Ophthalmology, Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors: Alireza
authors: A
authors: Peyman
keywords: Corneal cross-linking; endothelial cell density; keratoconus; pleomorphism; specular microscopy