Touriño Peralba, RosarioRodríguez Lago, JulioLamas Francis, DavidMartínez Pérez, LauraRodríguez Ares, María Teresa2025-06-232025-06-232025-02-10Touriño-Peralba, R., Rodríguez-Lago, J., Lamas-Francis, D. et al. Demographic and topographic findings suggesting poor response to crosslinking-iontophoresis in patients with progressive keratoconus. Int Ophthalmol 45, 69 (2025). https://doi.org/10.1007/s10792-025-03421-90165-5701https://hdl.handle.net/10347/42257Purpose: To evaluate demographic and tomographical parameters in predicting treatment response following transepithelial iontophoresis-assisted corneal cross-linking (I-CXL) for progressive keratoconus. Methods: Forty eyes (20 aged<19 years and 20 aged≥19 years) underwent I-CXL treatment between 2016 and 2022. Progression criteria based on the ABCD system, changes in asphericity (Q), demographic factors and keratoconus phenotypes were evaluated. Subjects were followed for 24 months after procedure. Results: Sixty percent of participants were male. The mean age at the time of treatment was 21.0±6.0 years. All tomographical values showed progression after 2 years of follow-up (p<0.05), particularly during the frst 6 months, except for anterior curvature. Within the ABCD grading system, we observed: A) an increase in anterior curvature, more evident with lower initial values; B) an increase in posterior curvature, more pronounced with higher initial values. Two years after I-CXL, 20% of subjects met progression criteria in two or more parameters, with 62.5% being under 19 years of age. Patients with a family history of corneal ectasia exhibited a mean KMax progression of 1.94D±1.88, (p=0.046). Only phenotypes 3 and 4 showed progression. Although patients under 19 years showed greater progression in all tomographical variables at the end of the study, this diference was not statistically signifcant. Conclusion: Treatment with I-CXL did not stop progression in the variables studied two years after the procedure in an efective manner, especially in patients younger than 19 years. A family history of corneal ectasia and subtype 4 keratoconus predicted a less favourable response to I-CXL.engThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holderAttribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/KeratoconusCross-linkingIontophoresisTransepithelialTomographyjournal article10.1007/s10792-025-03421-9open access