An Overview of Corneal cross-linking and How Can It Treat Keratoconus?

If an individual has been diagnosed with a certain corneal disease like Keratoconus or any other which weakens the cornea, the clinical process of Corneal cross-linking (CXL) can re-strengthen the cornea. Alternative medical terminologies for the procedure include corneal collagen cross-linking, KXL, CCL, corneal cross-linking and C3-R.

CXL is a minimally invasive procedure performed by application of liquid riboflavin (Vitamin B2) on the eye surface followed by beaming controlled ultraviolet light for eliminating corneal ectasia. The two basic types of corneal cross-linking (CXL) are:

  • Epithelium-off

In this specific procedure, the thin anterior/outer layer of the cornea (epithelium) is surgically removed which allow easy penetration of liquid riboflavin into the corneal tissue.

  • Epithelium-on

Also known as transepithelial CXL, it’s performed by leaving the protective corneal epithelial intact which takes riboflavin longer to load.

CXL can be merged with many other procedures to treat keratoconus. Take for instance implantation of Intacs; tiny arc-shaped corneal inserts alongside CXL has been successful at reshaping and restabilising the cornea but performed only on patients in their advance-grade keratoconus. A much higher severity can also lead to corneal transplant in Dubai but only recommended by expert surgeons.

The ideal candidates

The effectiveness of CXL is far better it the procedure is performed before cornea takes on a significant irregular shape or apparent vision loss from keratoconus or any other underlying cause of corneal ectasia. Early application of CXL would stabilise and can even improve the corneal shape which eventually results in better visual acuity and aptness to wear contact lenses.

Other major applications of the CXL include corneal ulcer(s) treatment that is ineffective or unresponsive to topical antibiotics. Research has indicated the effectiveness of CXL for removal or dissolution of various corneal infections.

Some of the surgeons also came forward with successful results of the process for corneal stability among the individuals who’ve undergone radial keratotomy; an invasive/incisional refractive process performed between the 1980s and 1990s. Cross-linking works best among the individuals experiencing daily vision fluctuation.

People who’re considering vision correction procedures such as LASIK or any other may require advanced treatment of CXL for strengthening of the eye surface so that it can bear the excimer laser ablation for corneal reshaping.

CXL – Expectations & outcome

Your eye doctor will measure corneal thickness during the initial examination to ensure candidate’s aptness for the procedure. The patient is likely to have a routine eye analysis for assessment of visual acuity and general eye health. Corneal topography (mapping of the cornea) is also performed to determine eye condition and severity of the onset.

It takes somewhere between 60 and 90 minutes for the CXL procedure to complete. For those receiving epithelial-off CXL, the surgeon will place the patient in a reclining position and proceed to remove the epithelial corneal layer after which riboflavin eye drops are applied.

Patients receiving epithelial-on CXL also take on a reclined position and application of riboflavin. After some time, the surgeon analyses if the cornea has sufficient level of riboflavin. Corneal thickness is also measured before beaming controlled UV light for approximately 30 minutes at Moorfields Hospital


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