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Abstract Purpose: This study aimed to evaluate and compare the Safety and Efficacy of Using Either Conventional or Accelerated Cross-linking for treatment of Corneal ectatic Diseases. Patients and Methods: It was a prospective non randomized comparative interventional study that was conducted in a private specialized eye hospital (eye care center) and Cairo university hospitals on 79 eyes of 43 keratoconus patients. Each patient was fully assessed preoperatively including doing corneal topography using the CSO Sirius and doing specular microscopy. accelerated CXL was done to 24 patients and conventional cross linking was done to19 patients. Postoperative investigation: Anterior Segment Optical Coherence Tomography was done one month post operatively to assess the depth of the demarcation line. Specular microscopy assessment was performed 1 month, 6 months and one year postoperatively. Corneal parameters (corneal curvature, CCT and biomechanics) was measured at 6 months of follow up and data was retrieved and analyzed. Results: There was a significant reduction in endothelial cell count particularly at one month post CXL, these changes were relevant in accelerated crosslinking group. There was a slight change in the percentage of hexagonal cells. Corneal stromal demarcation line depth measured with AS OCT was significantly deeper in conventional crosslinking group than the accelerated group, During the follow-up period, no significant difference was observed in pachymetric and elevation data postoperatively |