Study identifies risk factors for corneal crosslinking failure in keratoconus
Corneal crosslinking (CXL) is generally effective for stabilizing keratoconus, but a small percentage of patients are more likely to experience treatment failure and may require repeat crosslinking or corneal transplantation, according to a large analysis of real-world data from the American Academy of Ophthalmology’s IRIS Registry presented at AAO 2025.
Researchers evaluated 11,731 eyes from 8,568 treatment-naïve patients with keratoconus who underwent CXL between 2016 and 2022. Treatment failure was defined as the need for repeat crosslinking or progression to penetrating keratoplasty (PK) or deep anterior lamellar keratoplasty (DALK).
Overall, CXL failure occurred in 1.3% of eyes during the study period, leading to corneal transplantation (PK or DALK) in 36.5% and repeat CXL in the remaining eyes. The estimated failure rates increased over time, reaching 2.0% at 3 years and 4.5% at 5 years after the initial procedure.
Patients under 18 years old had twice the risk of experiencing treatment failure compared with adults (hazard ratio 2.02; P = 0.04). Unilateral treatment was also associated with a higher likelihood of failure (hazard ratio 1.54; P = 0.02).
Reference
Hwang B, et al. Rates and Risk Factors for Failure After CXL for KCN: An Academy IRIS Registry Analysis. Poster presented at: American Academy of Ophthalmology Annual Meeting; October 18–20, 2025; Orlando, FL.
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