Abstract:As a corneal ectatic disease, keratoconus is characterized by increased corneal curvature, progressive thinning, and anterior protrusion of the cornea. Initially, patients often experience progressive myopia and irregular astigmatism. As the disease progresses, severe visual impairment may occur. Corneal collagen cross-linking(CXL)is currently recognized internationally as the only effective treatment to halt the progression of keratoconus. After the surgery, changes in stromal curvature subsequently lead to the regeneration and redistribution of corneal epithelial cells. It has been observed that the process of epithelial remodeling plays a crucial role in maintaining the smoothness and symmetry of the corneal surface, as well as in improving the visual recovery. However, the specific mechanism of epithelial remodeling in the visual recovery and efficacy maintenance after CXL surgery is still unclear. This review comprehensively summarizes the morphological characteristics, temporal patterns and clinical significance of corneal epithelial remodeling after CXL surgery, compares the effects of different CXL protocols on epithelial thickness, and explores the potential value of epithelial remodeling in the assessment of postoperative efficacy and the design of personalized surgical strategies, aiming to provide directions for further clinical practice and research.
