For over 20 years, crosslinking has offered patients a safe, effective and gentle treatment that stops curvature and allows the cornea to stabilize through new collagen connections.
Crosslinking is used in refractive surgery to stabilize the cornea. This is necessary, for example, if the patient suffers from keratoconus or keratoderma (pellucid marginal degeneration of the cornea).
In contrast to a complex and risky corneal transplant, crosslinking (clx) can trigger a chemical reaction through the use of vitamin B2 (riboflavin) and UV light, which stimulates collagen crosslinking in the cornea. This strengthens and stabilizes the cornea. Protrusion can be prevented, slowed down or even easily reversed.
Find out more about the eye disease “keratoconus”, the symptoms, causes and treatment options:
The most important prerequisite for promising and safe treatment with crosslinking is sufficient corneal thickness:
This value is determined during your preliminary examination. If the corneal thickness is lower, the UV radiation cannot be sufficiently absorbed and there is a risk of damage to the endothelial cells on the inside of the cornea, which are responsible for pumping out water.
In addition, the curvature value should be less than 55 diopters amount. The Chances of success decrease with
Do you recognize the symptoms described above in yourself or your loved ones or do you already know that you have keratoconus? At EyeLaser Vienna and Linz, we can use state-of-the-art diagnostics to detect keratoconus and check whether you are suitable for crosslinking.
As part of your free suitability test, a measurement of the corneal thickness (pachymetry) and a surface measurement (topography) will be carried out. You will then have certainty and can decide on the basis of medical facts to act quickly and correctly!
After your free aptitude test with world-renowned eye surgeons, you will know whether you have keratoconus and whether crosslinking is promising for you:
During your aptitude test in conjunction with a non-binding, holistic preliminary examination (200 euros)*, we will develop an individual treatment plan for you:
*If you opt for treatment at EyeLaser, these costs will be deducted from the laser eye surgery costs.
Crosslinking for keratoconus and similar corneal diseases is gentle on the tissue, as the eye does not have to be “opened”, takes a maximum of two hours in total and can be performed on an outpatient basis at EyeLaser in Vienna or Linz.
To ensure you don’t feel any pain during the treatment, your eyes are numbed with eye drops. The top layer of the cornea is then removed, allowing the vitamin B2 (riboflavin) to penetrate deeper into the tissue and preventing the UV light from being filtered as strongly. The riboflavin ensures that the UV-A radiation to which the eye is subsequently exposed can be sufficiently absorbed. During crosslinking, the eye is irradiated with UV radiation for half an hour after the administration of vitamin B2.
The intensity of the radiation is regulated so that no tissue damage occurs, while still stimulating the formation of new cross-links in the cornea. These networks provide the necessary stability and prevent further bulging of the cornea. The corneal curvature is significantly more even afterwards, so that the visual defect can be corrected by wearing glasses or a refractive treatment (e.g. lens implantation or Trans-PRK).
Unfortunately, the stabilization of the cornea cannot be permanently guaranteed by crosslinking. The cornea renews itself completely within eight years. If the keratoconus is due to a hereditary predisposition, the instability will develop again. Therefore, most patients require another treatment after seven years.
If you repeat the procedure in good time before the keratoconus progresses, you will prevent the protrusion from intensifying. If you have your visual defect corrected by lens surgery or laser eye surgery after the first crosslinking, this visual defect correction will remain stable even after the second, third and subsequent treatments.
There are currently two methods for UV crosslinking. At EyeLaser Vienna and Linz, we mostly use the classic epi-off crosslinkingas the success rate is significantly higher.
We decide on your individual case which variant is promising and optimally suited for you. In the case of particularly mild keratoconus, the epi-on procedure may well be an option. In principle, however, we see the increased effectiveness (epi-off) as a reason to accept the slight discomfort – e.g. burning sensation – in the days following treatment, but the certainty that the cornea is sufficiently stabilized.
The upper corneal layer is scraped off, as it significantly impairs UV absorption. This allows the vitamin B2 to penetrate much deeper into the cornea and reach the stroma. With correct follow-up care and treatment, the risk of infection from the scraping is vanishingly small.
Penetration depth of vitamin B2: 400 µm
Success rate: over 95 percent
Keratoconus, PMD or keratoglobus can have a lasting negative impact on your quality of life and get worse and worse if you don’t treat it. At EyeLaser Vienna and Linz, we have already helped thousands of patients to stop the corneal bulge and sometimes even correct all visual defects in a follow-up treatment.
What happens if you opt for crosslinking:
To begin with, the abnormal corneal curvature must be diagnosed. At EyeLaser, we use state-of-the-art diagnostic equipment to precisely measure and record your corneal thickness, corneal structure and other parameters. This measurement data is also relevant for the subsequent crosslinking treatment. We use different methods for this. Progressive keratoconus, for example, is diagnosed by the change in corneal refractive power over a certain period of time.
As soon as the preliminary examinations have been completed, we will advise you on the most promising treatment and, if desired, draw up your individual treatment plan including all the documents you need for your health insurance company.
The actual treatment takes around 60-90 minutes – you should allow two hours for pre- and post-treatment care. The eye is anesthetized with eye drops so that you do not feel any pain.
The top layer of the cornea is removed mechanically so that the active ingredient riboflavin can penetrate deep enough into the cornea and not filter out too much of the UV-A radiation.
A small amount of vitamin B2 is now applied / dripped every three minutes for half an hour.
To stimulate the metabolism, the reconnection of the fibers and the formation of collagen compounds, your eye is then irradiated by a UV lamp for 30 minutes – the riboflavin continues to be dripped during this time.
The cornea needs time to heal after crosslinking. During this phase, slight pain and other mild side effects (e.g. red eyes, itching, burning, sensitivity to light, dryness) cannot be avoided. To alleviate these symptoms and avoid infections, you will receive a drop schedule for anti-inflammatory eye drops with an antibiotic agent and tear substitutes to keep the eyes moist. In the first few days after crosslinking, your eye is protected by a hard contact lens (bandage lens).
If complications arise or you need our advice outside of the scheduled follow-up appointments, we are of course always happy to help.
In some cases, a slight clouding of the stroma occurs. However, this disappears by itself after a few months and hardly affects you in everyday life. Afterwards, the clarity of the cornea is restored.
As soon as healing is complete, you can use soft contact lenses again. If these do not fit, wait at least 3 months after the treatment before refitting. Only then will the shape of your corneal tissue be stable enough for the lenses to be made to fit permanently.
With a follow-up treatment you can independent of wearing glasses or contact lenses make. The fact that the cornea is significantly more stable after crosslinking and the corneal curvature is more regular means that vision correction is much easier. for some patients possible – at the earliest six months after the procedure.
We insert an artificial lens (EVO VISIAN ICL) in addition to your natural lens. This additional lens corrects the visual defect – regardless of whether it is short-sightedness, long-sightedness or astigmatism. With this method, we can reliably correct even severe visual defects.
As an alternative to lens surgery, the visual defect can also be improved by laser surgery. The epithelium is removed and the surface of the cornea causing the ametropia is regularized, so that you can see more clearly again afterwards. There is no contact or flap, which makes the treatment particularly gentle, and the procedure can also be used for thin and/or irregular corneas.
Find out whether lens surgery is possible for you. Perfect for patients who are considering having their vision corrected.
No one should have to suffer from the effects and consequences of keratoconus. That is why we offer attractive financing options at EyeLaser Vienna and Linz. You do not necessarily have to pay the entire amount at once, but can significantly increase your quality of life with a small monthly installment.
Interest-free cross-linking financing over 6 months:
Cure your keratoconus without bureaucracy and without long-term credit commitments. Pay in six convenient monthly installments without having to add a cent of interest.
284 euros per month
Crosslinking financing for less than 29 euros per month over 5 years:
Together with our partner banks, we can offer you a five-year loan so that you only have to pay a small part of your budget each month.
29 euros per month*
* The term is five years. Effective annual interest rate: 6.21 percent. The prices refer to one eye.
Whether your health insurance covers the crosslinking costs depends on the individual case. Statutory health insurance companies are usually not willing or obliged to cover the treatment costs. However, there are also exceptional cases in Austria in which the statutory health insurance has fully covered the costs.
The likelihood of crosslinking costs being covered is significantly higher with private health insurance. Many insurance companies cover the costs – but not all of them. It depends on the contractually agreed benefits and possible supplementary insurance.
In any case, it is worth clarifying this question in advance with your health insurance company in order to have the necessary financial security. After the preliminary examination, we will be happy to give you the necessary medical documents, which you can submit to the health insurance company with a justification. The insurance company then checks whether the costs will be reimbursed.
We will discuss whether and which follow-up treatment can permanently correct your defective vision after crosslinking during your preliminary examination or after the crosslinking treatment at the Eye Laser Center Vienna / Linz.
Together we will find the best solution for your eyes that suits your visual impairment, your lifestyle and your budget.
Make an appointmentAfter epi-off crosslinking (clx) in particular, the removed corneal layer must heal and regress. Therefore, after the procedure, a soft, protective Contact lens (bandage contact lens) until the top layer has healed again. This usually takes between three and five days. Until the healing is complete, you should return to your check-up appointments to ensure that there is no infection.
But even after the acute healing phase, you can come to our laser eye center in Vienna or Linz at any time – apart from the regular check-up appointments – in case of complications or uncertainties. We will take care of you!
After treatment, many patients complain of pain, burning, watery and reddened eyes and a foreign body sensation. To alleviate this, EyeLaser will provide you with appropriate painkillers and/or eye drops.
Once the first phase of healing is complete, there are only mild symptoms such as a foreign body sensation or itchy eyes. Visual acuity increases until it is as it was before the treatment or even better after four to six weeks.
With a success rate of over 95 percent and a complication rate of well under 3 percent – including minor complications – crosslinking is considered to be extremely safe and low-risk for you as a patient.
It has been used worldwide since 2002 to stimulate the cross-linking of the cornea. Damage to the eyes caused by UV-A radiation is prevented by the precise determination of the harmless intensity.
There are hardly any side effects and there are no serious consequences, such as damage to the retina or lens have been documented. In over 97 percent of patients, there are no complications after crosslinking.
Dr. Victor Derhartunian, FEBO, FWCRS & Dr. Paul Jirak, FEBO, in Vienna & Linz – recognised by patients with the DocFinder Patients’ Choice Award
Dr. Victor Derhartunian, FEBO, FWCRS, heads EyeLaser Vienna and has performed more than 25,000 laser procedures. He advises patients in German, English, Polish and French.
Dr. Paul Jirak, FEBO, is a specialist in ophthalmology and co-founder of a laser eye surgery centre in Austria. He has been treating patients in Linz since 2014. His focus is eye surgery and laser eye surgery.
Dr. Leydolt is an ophthalmologist and specializes in cataract and lens surgery. She heads a research group with this focus, trains young surgeons and gives international lectures.
Crosslinking is the most important treatment method for keratoconus to stop the progression of corneal protrusion. Here you can find out all about this proven therapy: how it works, who it is suitable for and what results you can expect.
No, crosslinking itself does not cause any pain. Before the treatment, your eyes are anaesthetized with special eye drops so that you will not feel any pain. Only in the days following crosslinking, when the corneal surface heals, may you experience some unpleasant pain. You have the option of treating this with eye drops and painkillers. You should no longer feel any pain after a week at the latest.
This depends on the individual case. If crosslinking is the most suitable medically necessary treatment for keratoconus, statutory health insurance may also cover this treatment. As a rule, however, crosslinking is not covered by statutory health insurance. If you have private health insurance, the likelihood of costs being covered is higher – but this is not guaranteed here either. In any case, ask in advance – preferably with medical findings – and find out whether you can expect partial or full cost coverage.
If you undergo crosslinking treatment at EyeLaser, our surgeons and doctors will explain to you exactly what you need to pay attention to so that the healing process is as quick and complication-free as possible. We have put together a short overview of the most frequently asked questions after crosslinking:
What to do if your eye itches?
You should definitely avoid applying friction and mechanical pressure to the eye in the first few weeks. Constantly touching the eye should cause the keratoconus to progress further.
When can I do sports after crosslinking?
In the first week after treatment, you should avoid strenuous activities if possible. Sweat poses a risk of infection for your eye. As soon as the healing of the corneal surface is complete, you can slowly start again.
When can I drive after crosslinking?
That depends on your eyesight or your visual defect. At least immediately after the treatment, you should ensure that you are picked up or travel home by public transport. That is safer.
How long will I be on sick leave after crosslinking?
Usually only a few days to a week. The important thing is that you can then see well enough to carry out your work safely as usual and are not restricted.
How often and which eye drops after crosslinking?
Your doctor will tell you. You will receive a precise drop schedule, from which you should not deviate on your own authority under any circumstances. Regular application of suitable eye drops is essential for healing.
When can I start wearing my contact lenses again after crosslinking?
Wait at least four weeks. It is possible that your “old” lenses no longer fit you or that they fit poorly. In this case, your contact lenses should be adjusted. It only makes sense to have your lenses fitted after three months.
When can I shower / swim after crosslinking?
In the first week, make sure that no water gets into the eye. Small drops are not a problem. However, you should completely refrain from swimming and using the sauna until the corneal surface has healed.
7 years. Unfortunately, the stabilization of the cornea through crosslinking is not permanent. This is because the cells of the cornea regenerate completely on average about every 8 years. The collagen cross-links / cross-linkages responsible for the lack of stability have re-formed due to the predisposition, and a new treatment with vitamin B2 and UV light may be necessary.
But through the treatment, you prevent the protrusion of the cornea from developing further and increasing. Repeated treatment with crosslinking leads to the maintenance of the improved visual acuity, which was made possible by the follow-up treatment after the first crosslinking. At the same time, the repeated treatment through crosslinking maintains the improvement in visual acuity that a follow-up treatment after the first time made possible.
Keratotorus is the “opposite” of keratoconus. In contrast to the thinned cornea, in keratotorus (also called PMD), the corneal edge is affected. This thickens and stiffens. This form of eye disease is not easy to distinguish from keratoconus and is often confused. However, PMD can usually be corrected well with glasses. This is because the center of the cornea is not affected, but is only “pulled along” by the stiffened corneal edge.
Keratosis (pellucid marginal degeneration of the cornea) can also be treated with UV crosslinking.
Crosslinking is one of the most frequently used treatment methods for keratoconus – a cone-shaped protrusion of the cornea. To stop or even reverse this, the cornea is treated with special UV light and riboflavin (vitamin B2). This is intended to strengthen and stabilize the cornea with collagen fibers.
Crosslinking is worthwhile for every patient diagnosed with beginning or even advanced keratoconus. There are few other methods to stop the protrusion. Untreated, keratoconus and PMD can lead to severe symptoms and even loss of vision. Individual suitability is determined during the preliminary examination.
The treatment takes between 30 and 60 minutes. You feel no pain and can lie down quite relaxed. First, riboflavin is applied to the cornea. Then it is irradiated with special UV light, which stimulates the formation of collagen fibers and results in the stability of the cornea increasing and a protrusion being stopped, slowed down or even slightly reversed.
Possible side effects of crosslinking can include short-term eye irritation, a slight burning sensation and increased sensitivity to light. Blurred vision is also normal shortly after treatment. Infections or scarring are extremely rare. The overall risk is extremely low if crosslinking is performed correctly and professionally supervised by an ophthalmologist/specialist.
Stabilization of the cornea begins immediately after the first treatment. However, it usually takes between three and six months for the full effect to develop. The minimum requirement for crosslinking is that progression is halted. In some cases, patients’ visual acuity may even improve slightly.
Almost everyone who comes to us has the same questions in mind and does not always dare to ask them. Here are the honest answers.
The treatment itself does not; the eye is numbed with drops. To be honest: after epi-off cross-linking the eye burns and waters for two to four days until the top cell layer has closed again. A bandage lens, drops and painkillers make this quite bearable.
The aim is to stop the progression, not to increase visual acuity. Many see somewhat better after months because the cornea reshapes slightly; glasses or contact lens correction usually remain necessary. For visual acuity there are CAIRS, toric ICL or Trans-PRK afterwards.
The UV light is precisely controlled in dose and duration; that is why a corneal thickness of at least 400 µm is required so that the endothelial cells stay protected. The real, rare risk is an infection during the days of healing: antibiotic drops, bandage lens, close check-ups.
In more than 95 percent of those treated the deformation comes to a halt. In rare cases a second treatment is possible years later. The topography check after 6 and 12 months shows whether the cornea is stable.
After healing (about 4 to 6 weeks) contact lenses are refitted because the corneal shape changes slightly. For those who tolerate them poorly, CAIRS or a toric ICL are the next steps.
With keratoconus time works against the cornea: the earlier it is stabilised, the more vision is preserved. Still, the first step is only a measurement (topography, pachymetry), without obligation. Then we calmly discuss whether and when cross-linking is needed.
We answer further questions in the FAQ below or in person at the suitability check.
„From the very first moment I felt in the best hands with Dr. Derhartunian. The whole team is incredibly friendly, well organised and really takes time for every patient.”
„I am very happy that I made this decision. One year after the operation everything is in perfect order. Getting up in the morning and not needing glasses any more is a completely different feeling.”
Cross-linking is the first step. What comes afterwards and where you can read more about the condition:
