Crosslinking: How crosslinking can cure keratoconus
What is crosslinking?
Corneal crosslinking (CXL) is used as a treatment method to stop corneal ectasia.
Crosslinking is intended to stabilize the cornea by cross-linking it.
This stops progressive ectasia – the most common treatment for progressive keratoconus.
In the case of ectasia, the cornea bulges outwards and the cornea becomes thinner.
Treatment with CXL strengthens the cornea in such a way that the progression of the bulge then stagnates.
Crosslinking – a stabilization of the cornea through a photochemical process.
Using UV light and vitamin B (riboflavin) to achieve crosslinking of the cornea.
The UV light causes the riboflavin to be activated.
Oxygen radicals are released.
These in turn bind carbon and nitrogen groups together – cross-linking.
This cross-linking ensures the newly acquired strength of the cornea.
Due to the stability, further protrusion of the cornea is no longer possible – the progression of the disease is halted.
Crosslinking is proving to be an effective treatment method when it comes to ectasia.
Where previously only high-risk corneal transplants could help, crosslinking can now provide a remedy.
There are two types of crosslinking:
- EPI-OFF crosslinking – epithelium is removed before the riboflavin is applied
- EPI-ON Crosslinking – epithelium is only loosened before the riboflavin is applied
Requirements for crosslinking
If you decide to undergo CXL treatment, your corrected visual acuity should be less than 0.3.
Your cornea should have a minimum thickness of 400 µm.
Reasons for excluding crosslinking may be
- Corneal curvature of >55 diopters
- Corneal scarring
- Pregnancy or breastfeeding
- Acute eye infections
When is crosslinking recommended?
CXL is useful for all progressive corneal ectasias – including keratonocus.
Both adults and children can be treated.
It is important that treatment is started as soon as possible.
Crosslinking cannot reverse the disease, but ensures that the progression of the ectasia is halted.
The earlier intervention takes place, the more vision can be preserved.
CXL should therefore always be considered if there is still usable vision that can be corrected with visual aids.
Crosslinking procedure
Anesthetic eye drops are applied before the outpatient procedure so that you feel the crosslinking is painless.
The next steps of the treatment using an eyelid holder:
- With Epi-Off: The epithelium is removed using a slit lamp, cotton swab and solution.
- Riboflavin is applied to the eye.
- Up to 30 minutes application time.
- Light source is directed at the eye for 10-15 minutes.
After the operation
After the procedure, some patients experience slight pain, which can be alleviated with painkillers.
Antibiotic eye drops are also administered.
A protective lens is inserted to protect the eye from external influences.
This prevents any disruption to the healing process.
You should also take note:
- No eye rubbing
- No water contact within the first week
- Adhere to medication and eye drop schedule
- Attend check-ups
Slight clouding, redness, watery eyes and blurred vision may also occur after crosslinking.
These symptoms are not usually a cause for concern.
However, if you have any questions or concerns, you can contact us at any time or make another appointment for a check-up.
You should always consult a doctor in the event of sudden deterioration.
Risks and side effects of crosslinking
Crosslinking is considered an inexpensive, effective and safe method with a low complication rate of less than three percent.
At the same time, the success rate of the treatment is 98-99 percent.
As with any medical procedure, complications and side effects cannot be completely ruled out.
The rare complications that do occur are often:
- Prolonged healing processes
- Scarring
- Pain
- Inflammation and infections of the cornea
Complications can usually be treated well with medication or eye drops.
Permanent damage or serious side effects from crosslinking are not known to date.