PurposeTo evaluate the topographic, refractive, and pachymetric changes after ethanol-assisted transepithelial corneal cross-linking (CXL) to stabilize progression of keratoconus (KC).Patients and methodsThis study retrospectively evaluated the long-term topographic, refractive, and pachymetric changes in patients diagnosed with KC who underwent corneal cross-linking and/or intrastromal corneal ring segment (ICRS) implantation. The subjects were divided into three groups, corresponding to eyes treated with CXL alone (group1), CXL and ICRS at the same time (group2), and CXL after ICRS implantation (group3). Corrected visual acuity and refraction, steep keratometry (SteepK) values, steepest keratometry reading on sagittal curvature map, and corneal thickness were recorded preoperatively and at each visit. Changes between measurements were assessed during follow-up.ResultsCorrected distant visual acuity (CDVA) values improved in all groups compared with baseline, but the differences were not statistically significant except for the first year (p>0.05). In groups1 and 3, SteepK values did not change statistically significantly during the entire follow-up (p>0.05). In group2, SteepK values statistically significantly decreased at all follow-up examinations compared with baseline, determined as the first month after ICRS implantation (p<0.05). Complication rates were acceptable without any need for surgical intervention.ConclusionsSingle-session ethanol-assisted transepithelial CXL with or without ICRS implantation was a safe and effective procedure to halt progression of KC.