In conclusion, despite the small risk of early postoperative complications, CXL PLUS was an effective way of improving refractive status in eyes with keratoconus during 18 months of follow-up. However, CXL plus was more effective in correcting the myopic component of of keratoconus than the astigmatic component. Most complications occuring after CXL plus could be attributed to removal of epithelium. Unfournately, CXL plus cannot be regarded as a completely safe procedure.Moreover, there was a high rate of progression of keratoconus postoperatively. Further prospective studies using standard CXL instead of accelerated CXL are needed to evaluate the stability, efficacy and safety of CXL plus.