Corneal Cross-Linking Surgery
What Is Corneal Cross-Linking Surgery?
For those who suffer from keratoconus, the normally round, dome-like cornea (the clear front window of the eye) becomes thin and develops a cone-like bulge that distorts vision. Eyeglasses and rigid contacts can often provide substantial help while in early stages of the disease, but in later-stage or severe cases, a corneal cross-linking may become necessary.
Corneal collagen cross-linking (CXL) is a treatment available at the Dean McGee Eye Institute that can halt the progression of keratoconus, and is the only FDA-approved cross-linking treatment. In fact, DMEI was part of the original FDA study 404 and is one of the first providers in the country to offer corneal cross-linking surgery since its approval
CXL works by strengthening the linkage between collagen fibers in the cornea, thus making it more stable. This stops the thinning process and allows the cornea to better hold its shape and focusing power for better visual acuity. It is important to stress that CXL will not make vision better (there are other options for improving vision, including both non-surgical and surgical options); the primary goal of CXL is to prevent keratoconus from getting worse.
Who’s A Good Candidate for a Corneal Cross-Linking?
The best candidates for corneal cross-linking are those with documented disease progression of keratoconus. Your corneal specialist will discuss further details with you on whether or not you are a good candidate, as other factors, such as age, are important as well.
The Procedure
CXL is performed as an office visit without surgical incisions. Prior to the procedure, your eyes will be numbed using eye drops. The thin layer of the cornea, the epithelium, will be removed. This is known as “epi-off cross-linking”, which is the FDA-approved protocol. Riboflavin (Vitamin B2) is then applied to the cornea. After this, you will lie on your back in a chair as an ultraviolet light is used in combination with the riboflavin to trigger bonding (cross-linking) of collagen molecules in the cornea. A contact lens is placed on the cornea at the end of the procedure.
Currently, “epi-on cross-linking” is undergoing FDA trials. You may wish to talk to your DMEI cornea specialist to see what options are available for patients whose corneas are too thin for the epi-off protocol.
Are There Any Risks with Corneal Cross-Linking Surgery?
CXL has a low rate of risks or complications, but there are a few, including:
- Defect or delay in the healing of the epithelium (corneal abrasion)
- Keratitis (infection)
- Scarring
We encourage you to speak with your surgeon about possible side effects.
Preparing for a Corneal Cross-Linking
Your ophthalmologist will inform you of any steps to take prior to the procedure. You’ll also need to arrange for someone to drive you home after your procedure, as your eyesight will be affected.
Recovery Time
Your vision may be blurry for a few days (up to a week) after the procedure, so you may want to adjust your work and home schedule accordingly. You can resume normal activities the very next day as long as your vision and eye comfort levels allow. The contact lens will be removed within a few days after the surgery. You will have to use eye drops afterward as directed by your cornea doctor. After a few weeks, we will check your vision again for any updates that might be needed to your glasses and/or contact lenses. Patients who wear contact lenses may cautiously return to contact lens wear as per the instructions of your cornea doctor.
