A Randomized Clinical Trial of Ex Vivo Corneal Cross-Linking of Donor Keratoplasty Tissue for Keratoconus Used for Keratoplasty in Keratoconus Patients

Inclusion Criteria: * Willing and able to provide written informed consent. * Willing and able to comply with study assessments for the full duration of the study. * Age ≥18 years but ≤50 years * History of keratoconus (without a previous transplant) requiring keratoplasty * Willing to commit to not having further cross-linking, corneal relaxing incisions, intacs, or corneal laser vision correction during the course of the study Exclusion Criteria: * Age \< 18 years \>50 * Inability to provide written informed consent and comply with study assessments for the full duration of the study * Participation in another simultaneous interventional medical investigation or trial Systemic * History of Stevens-Johnson syndrome or ocular pemphigoid * Signs of current infection, including fever and current treatment with antibiotics * Pregnancy (positive pregnancy test) or lactating * Pre-menopausal sexually active women not using adequate contraception (Reliable intrauterine devices, hormonal contraception or a spermicide in combination with a barrier method) Recipient Eye * Corneal or ocular surface infection within 30 days prior to study entry * History of previous cross-linking * History of previous corneal transplant * Non-healing epithelial defect of at least 0.5x0.5 mm in host corneal bed lasting ≥6 weeks preoperatively * Ocular or periocular malignancy * Lid abnormalities that in the opinion of the investigator could confound the study results and these include clinically s…