Unusual ectasia following corneal cross-linking in a patient with keratoconus.

Objective: Description of an unusual ectasia following corneal cross-linking (CXL) in a patient with keratoconus. Methods: Clinical case report and review of the literature. Results: We present a case of an unusual ectasia after corneal CXL in a patient with keratoconus. Discussion: This case reports the first known occurrence of corneal ectasia following epi-off CXL, a procedure typically used to halt the progression of ectatic disorders such as keratoconus. Although the standard protocol was followed, subtle technical variations or postoperative healing factors could have contributed to the outcome. Conclusions: This case underscores the need for ongoing vigilance in patient selection and follow-up in the context of CXL. The rare development of corneal ectasia post-CXL highlights a gap in our understanding of corneal biomechanics and the potential limitations of current diagnostic tools. More research is needed to refine patient screening methods and optimize treatment protocols to ensure the efficacy and safety of this widely used procedure.