Corneal crosslinking (CXL), also known as corneal collagen cross-linking (CCL, or C3R), is a minimally invasive procedure that strengthens the cornea. Corneal crosslinking has been used to prevent the progression of corneal ectasia, such as keratoconus and post-LASIK ectasia. The procedure involves applying a vitamin B solution to the eye and then exposing it to ultraviolet light for about 30 minutes or less. This strengthens the collagen fibers in the cornea and helps prevent it from bulging further. In this article, we will answer some of the most common questions about CXL for keratoconus.
What is corneal collagen crosslinking?
Corneal collagen crosslinking (CXL) is a minimally invasive procedure that is used to prevent progression of corneal ectasia such as keratoconus and post-LASIK ectasia. The procedure involves the use of ultraviolet light and riboflavin eye drops to strengthen the collagen fibers in the cornea. The cross-linking of collagen fibers helps to increase the strength and rigidity of the cornea, thereby preventing further bulging or thinning of the cornea. The procedure is generally safe and effective, with a low risk of complications.
How does corneal collagen crosslinking work?
The cross-linking of collagen fibers helps to increase the strength and rigidity of the cornea, thereby preventing further bulging or thinning of the cornea. The procedure is generally safe and effective, with a low risk of complications. The procedure involves the following steps:
- The surface layer of the cornea is removed to allow the riboflavin eye drops to penetrate the cornea.
- The riboflavin eye drops are applied to the cornea, which is then exposed to ultraviolet light for a specific duration.
- The ultraviolet light activates the riboflavin, which causes the collagen fibers in the cornea to crosslink and become stronger.
- A bandage contact lens is placed on the eye to protect it while it heals.
What are the benefits of corneal collagen crosslinking?
The benefits of corneal collagen crosslinking (CXL) include:
- It helps prevent further deterioration of vision.
- It increases corneal rigidity, resistance, and biomechanical stability.
- It prevents the progression of keratoconus disease.
- It may defer the need for a corneal transplant procedure.
- It may reduce the myopia and astigmatism associated with keratoconus.
What are the risks of corneal collagen crosslinking?
It is important to note that these risks are rare, and CXL is generally considered a safe and effective procedure with a low risk of complications. The risks of corneal collagen crosslinking (CXL) include:
- Corneal haze.
- Corneal epithelial defect (disruption of surface cells) or delayed epithelial healing.
- Postoperative infection, ulcer.
- Treatment failure. Keratoconic progression following treatment.
What are the different types of corneal collagen crosslinking?
There are two basic types of corneal collagen crosslinking (CXL): epithelium-off and epithelium-on.
Epithelium-off CXL: In this type of CXL, the outer layer of the cornea (epithelium) is removed to allow for more deep tissue to be penetrated by the riboflavin liquid.
Epithelium-on CXL: In this type of CXL, the outer layer of the cornea is left intact, and the riboflavin liquid is applied to the surface of the cornea.
Is corneal collagen crosslinking FDA approved?
Yes, corneal collagen crosslinking (CXL) is FDA approved for the treatment of progressive thinning and distortion of the cornea, specifically for keratoconus and other types of corneal ectasia.
What is the recovery time after corneal collagen crosslinking?
The recovery time after corneal collagen crosslinking (CXL) varies from person to person, but it typically takes several weeks for the eye to fully recover. During this period, it is important to follow the surgeon’s instructions diligently to promote healing and avoid any complications. Most people are able to get back to their normal daily activities within 1-2 weeks of cross-linking. However, your vision may not be fully stable for several months, which means your “best-corrected” vision (your eyeglasses or contacts prescription) will likely change during this time.
How much does corneal collagen crosslinking cost?
The cost of corneal collagen crosslinking (CXL) varies depending on the location and the type of procedure. In general, the cost of CXL for the treatment of progressive keratoconus typically ranges from $2,500 to $4,000 per eye. Insurance coverage for FDA-approved epithelium-off cross-linking with the KXL System and Photrexa drug formulations from Glaukos is widely available.
Does corneal collagen crosslinking hurt?
Corneal collagen crosslinking (CXL) is considered a minimally invasive procedure and is generally considered to be painless. During the procedure, your eyes will be numbed with anesthetic eye drops, so you should not experience any pain. However, some patients may experience mild discomfort or a gritty sensation in the eyes after the procedure. This discomfort can usually be managed with over-the-counter pain medications or prescription eye drops.
Who is a good candidate for corneal collagen crosslinking?
Corneal collagen crosslinking (CXL) is generally recommended for individuals with progressive ectatic diseases of the cornea such as keratoconus, post-LASIK ectasia, and pellucid marginal degeneration. The procedure is also suitable for individuals with corneal warpage, irregular astigmatism, and corneal infections that fail to heal.
It is important to note that CXL is most effective when the disease is in its early stages. Therefore, it is recommended that individuals with progressive ectatic diseases of the cornea undergo CXL as soon as possible to prevent further deterioration of vision.
Can corneal collagen crosslinking be repeated?
Yes, corneal collagen crosslinking (CXL) can be repeated if necessary. However, the decision to repeat the procedure depends on the individual’s specific condition and the surgeon’s recommendation. In general, it is recommended that patients wait at least 6 months after the initial procedure before considering a repeat procedure.
Can corneal collagen crosslinking be done on both eyes at the same time?
Yes, corneal collagen crosslinking (CXL) can be performed on both eyes at the same time. However, the decision to perform the procedure on both eyes simultaneously depends on the individual’s specific condition and the surgeon’s recommendation.
Can corneal collagen crosslinking be done on children?
Yes, corneal collagen crosslinking (CXL) can be performed on children. Corneal collagen cross-linking can be considered a safe and effective procedure in the children with progressive keratoconus. Extra care is needed in pediatric patients, as they are more prone to infections and a heightened allergic response. Parents should be well informed about CXL and the possibility that repeat treatment may be required.
Can corneal collagen crosslinking be done on pregnant women?
There are no long-term studies about the effect of corneal collagen crosslinking (CXL) on pregnancy and lactation. According to a manufacturer, crosslinking should not be performed on pregnant women. It is recommended that women who are pregnant or planning to become pregnant discuss their options with their ophthalmologist.
What are the success rates of corneal collagen crosslinking?
The success rates of corneal collagen crosslinking (CXL) vary depending on the patient and the severity of the condition. However, overall, success rates for CXL are considered to be very high. When the first human trials for the procedure were performed in 2003, all patients suffering from progressive keratoconus saw the progression stop. A study conducted in Australia found that cross-linking under the Dresden protocol appears to be safe and has a success rate of around 70-90% in stabilizing keratoconus, depending on the patient. Another study found that CXL is very effective, with a success rate of more than 95% for an ‘epi-off’ treatment. In the remaining 5% of patients where there is further progression or change, a second treatment may be required.
Can corneal collagen crosslinking be done on people with systemic diseases?
The suitability of corneal collagen crosslinking (CXL) for individuals with systemic diseases depends on the specific condition and the surgeon’s recommendation. In general, patients with systemic diseases such as lupus, rheumatoid arthritis, and diabetes may be at a higher risk of complications following CXL. It is important to consult with an ophthalmologist or optometrist to determine if CXL is a viable treatment option for your specific eye condition.