Cornea Cross Linking (CXL)

Corneal Cross linking is a surgical procedure designed to stiffen the collagen within an abnormally flaccid cornea that has demonstrated topographic signs of early and “progressive” warpage. “Cross-linking” collagen fibers together strengthens and reinforces the cornea. It is important to also realize, that corneal collagen naturally becomes more rigid with age.

Collapse Cross-linking is FDA approved for use in patients with:

1. Keratoconus with proven progression by serial topography. The cornea begins warping in younger patients with Keratoconus in their teens or 20’s. It can be exacerbated with eye rubbing and the progressive warpage can often be arrested simply by stopping this repetitive activity and eliminating the unwanted stress on the cornea. Since the cornea naturally cross-links (stiffens) with age the warpage naturally stops in the majority of keratoconus patients in their mid 30's to mid 40's. For these reasons, cross-linking is BEST utilized in MILD keratoconus detected in YOUNGER patients BEFORE visually significant corneal warpage requiring hard contact lenses occurs!

2. Corneal warpage and proven topographic progression caused by Refractive surgery such as LASIK or PRK. In these rare cases, the cornea is weakened due to laser subtraction of cornea tissue. Those with LASIK, PRK are suitable candidates for corneal cross linking ONLY IF DETECTED EARLY by serial Corneal Topography measurements - that is, BEFORE cornea warpage advances to the point where you do not see well during all lighting conditions (day and night) with corrective lenses (glasses and SOFT contact lenses).

Once you can no longer adequately see with glasses or soft contact lenses, particularly at night, the cornea warpage has likely progressed to the point that cross linking will be far less effective. Making a significantly warped cornea biomechanically more rigid by cross-linking may only incrementally normalize (flatten) the abnormal corneal cone shape and may take years to do so. Vision quality with glasses or soft contact lenses may still be inadequate, particularly at night. Hard contact lenses may be required and if you are contact lens intolerant, cornea transplantation (DALK large diameter) may be indicated.

Those with LASIK, PRK are suitable candidates for corneal cross linking ONLY IF DETECTED EARLY by serial Corneal Topography measurements - that is, BEFORE cornea warpage advances to the point where you do not see well during all lighting conditions (day and night) with corrective lenses (glasses and SOFT contact lenses). If you fall into this category and proceed with corneal cross linking, and the procedure "fails" to improve vision with corrective lenses and you are hard contact lens intolerant, then this can make subsequent cornea transplantation (DALK large diameter) technically more challenging.

Corneal crosslinking is, in our opinion, contraindicated in those with Radial Keratotomy (RK) induced ectasia (warpage) with or without diurnal fluctuation (may require several pairs of different prescription glasses throughout the day). It is not FDA approved for this indication and for good reason. In our very strong opinion this treatment should be avoided and cornea transplantation (DALK large diameter) should be strongly considered as this is, in our hands, the ONLY way to fully and permanently restore the cornea in these patients!

Cross-linking is an outpatient procedure…you return home the same day after surgery.

• While lying down, you will be given drops to numb your eyes.
• Your ophthalmologist removes the thin, outer layer of the cornea (epithelium). This allows the Riboflavin to penetrate deeper into the cornea.
• Vitamin B (riboflavin) eye drops are applied to the cornea for about 30 minutes.
• Next, a special UV light device shines a focused beam at your cornea for about 30 minutes. The UV light “activates” the riboflavin now within the cornea. This helps form new collagen bonds in your cornea.
• A bandage contact lens is placed over the eye(s). This helps you feel more comfortable during the healing process. The bandage lens is left in place for about a week.
• Your ophthalmologist may give you antibiotic and steroid drops.

Here are some common side effects of cross linking surgery:

• Foreign body sensation in the eye
• Light sensitivity
• Dry eye
• Hazy or blurry vision
• Eye discomfort or pain

Your vision will be very blurry at first but should gradually improve within two to three weeks.

If you have severe eye pain, or a sudden change/loss of vision, call your doctor immediately!

Most people return to normal daily activities within 1-2 weeks.

Your vision may not be fully stable for several months. This means your eyeglass or contact lens prescription will shift during this time. After several months, your doctor will likely need to change your glasses or hard contact lens prescription.

While cross-linking does not make your existing corneal bulging and thinning return to normal, the goal is to keep keratoconus or ectasia from getting worse. For many people, where the warpage is caught EARLY, cross-linking prevents the need for additional surgery, like a cornea transplantation (DALK large diameter).

Cross-linking can cause serious short and long-term corneal side effects, including but not limited to:

• Infection
• Cornea haze/scarring
• Worsening of keratoconus
• Loss of vision

If you have severe eye pain, or a sudden change/loss of vision, call your doctor immediately!