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We would like to thank the authors' for their comments. The point they are making is rather interesting but we would like to point out that our study1Kymionis G.D. Kounis G.A. Portaliou D.M. et al.Intraoperative pachymetric measurements during corneal collagen cross-linking with riboflavin and ultraviolet A irradiation.Ophthalmology. 2009; 116: 2336-2339Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar was held in accordance with the original and standard corneal collagen cross-linking (CXL) protocol in which an eyelid speculum is used from the beginning of the procedure and throughout the 30-minute riboflavin instillation step.Nevertheless, it is obvious by the findings presented, that the authors found decreasing central corneal thickness (CCT) values when the eyelid speculum was used, during the 30 minute irradiation step, in complete accordance with our study results. Furthermore, since CXL is a relatively new technique, procedure alterations (such as the lack of eyelid speculum during riboflavin instillation) have to be tested in large patient series (3 patients is a rather small sample) and long follow-up periods to verify their value.Corneal exposure and dehydration is inevitable during the CXL procedure especially in the 30-minute irradiation part of the application. This finding should be taken care of during CXL application in order to maximize the safety level of the procedure and reassure a successful and lasting outcome. We would like to thank the authors' for their comments. The point they are making is rather interesting but we would like to point out that our study1Kymionis G.D. Kounis G.A. Portaliou D.M. et al.Intraoperative pachymetric measurements during corneal collagen cross-linking with riboflavin and ultraviolet A irradiation.Ophthalmology. 2009; 116: 2336-2339Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar was held in accordance with the original and standard corneal collagen cross-linking (CXL) protocol in which an eyelid speculum is used from the beginning of the procedure and throughout the 30-minute riboflavin instillation step. Nevertheless, it is obvious by the findings presented, that the authors found decreasing central corneal thickness (CCT) values when the eyelid speculum was used, during the 30 minute irradiation step, in complete accordance with our study results. Furthermore, since CXL is a relatively new technique, procedure alterations (such as the lack of eyelid speculum during riboflavin instillation) have to be tested in large patient series (3 patients is a rather small sample) and long follow-up periods to verify their value. Corneal exposure and dehydration is inevitable during the CXL procedure especially in the 30-minute irradiation part of the application. This finding should be taken care of during CXL application in order to maximize the safety level of the procedure and reassure a successful and lasting outcome. Pachymetry during Cross-linkingOphthalmologyVol. 117Issue 10PreviewWith great interest we read the article by Kymionis et al1 who evaluated central corneal thickness (CCT) using ultrasound pachymetry during corneal cross-linking (CXL). An eyelid speculum was used while riboflavin drops were instilled every 3 minutes during 30 minutes, after which 30-minute ultraviolet-A (UVA) irradiation was performed. They demonstrated that CCT significantly decreased from 415.7 μm after epithelial removal to 340.7 μm after riboflavin instillation. They found no significant change in CCT during irradiation. Full-Text PDF