Abstract: Keratoconus(KC) is a common congenital, progressive, non-inflammatory degenerative corneal disorder. Corneal collagen cross-linking can increase corneal stiffness and control disease progression. Enhanced riboflavin penetration is achieved through iontophoresis and penetration enhancers; improved oxygen supply for better cross-linking efficacy is facilitated by pulsed light, oxygen delivery devices, and graphitic carbon nitride quantum dot-based oxygen self-supply platforms; riboflavin formulations using hydroxypropyl methylcellulose as a carrier prevent intraoperative corneal thinning; Rose Bengal-green light illumination combined with chemical cross-linking agents reduces biotoxicity; customized ultraviolet collagen cross-linking targeting specific weakened corneal areas maintains keratoconus stability; and epithelial-sparing riboflavin cross-linking protocols overcome the corneal epithelium barrier against large/hydrophilic drug molecules while avoiding complications associated with epithelial debridement.

Key words: Keratoconus, Corneal collagen cross-linking, Oxygen, Riboflavin