Cross linking
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Cross linking
Corneal crosslinking (CXL) was developed in 1998 by Theo Seiler, MD (whom Dr. Chynn knows) and has been shown in numerous clinical trials to strengthen the cornea to treat conditions such as:
- Keratoconus (KC)
- Pellucid Marginal Degeneration (PMD)
How is the cross-linking procedure done?
The simple procedure is done in-the clinic and it is entirely painless.
- 1. A well trained technician will drop a special solution of riboflavin (B-vitamin) on your cornea for 30 minutes.
- 2. Next, your eyes will be exposed to 10-30 minutes of UV light. The intensity of these light waves are similar to the sterilizing blue lights you’ve seen at the deli counter.
Cross-linking
Are there different types of Corneal Crosslinking?
Epithelium off, which means the thin layer covering the eye’s surface is removed, allowing for faster penetration with liquid riboflavin, and more effective crosslinking. This is the type we perform, and are the best at getting the epithelium to grow back quickly without pain or scarring, because we perform nearly 1,000 PRK per year, where we also remove the epithelium and need it to grown back rapidly, so have THE experience 🙂
Transepithelial corneal crosslinking (epithelium on) is where the corneal epithelial surface is left intact, which requires a longer riboflavin loading time. Many published studies have shown this method to be less effective than epi-off, and NO study has shown epi-on to be MORE effective–leading to the conclusion that epi-on is LESS effective than epi-off. So why leave the epithelium on, and have your CXL maybe not work–rather than get epi-off and have it be EFFECTIVE at a center that is EXPERIENCED at getting your epithelium to grow back quickly?
Are there different types of Corneal Crosslinking?
CXL as a treatment for keratoconus is a promising procedure that leads to very positive results – with minimal risks involved. It was approved for use in Europe over 10 years ago, and it has been performed safely and successfully on tens of thousands of patients worldwide.
Regarding complications, the most common complaint is that CXL doesn’t stabilize the cornea and the patient’s condition continues to deteriorate. Simply put, CXL doesn’t work. However, this is the same outcome as if the procedure was never done – so it isn’t much of a “complication.”
Very rarely, people experience scarring or haze as a complication, or they have endothelial decompensation that requires a corneal transplant to correct it. Of course, had many of these same patients not undergone CXL, they may have eventually needed a corneal transplant to treat their keratoconus.
Best Candidates For Corneal Crosslinking
- Patients with Corneal Ectactic Disorders (Keratoconus or Pellucid Marginal Degeneration)
- Patients with ectasia/regression/need a reoperation after LASIK
- Patients with high prescriptions or thin corneas considering cutting vision correction procedures such as LASIK might eventually be pre-treated with corneal crosslinking to strengthen the eye’s surface beforehand (this is known as the “Athens Protocol” and was developed by John Kannelopoulos, MD, who trained at Harvard with Dr. Chynn who trained Dr Omar 😃
- PMD(Pellucid Marginal Degeneration)
What Can You Expect After Corneal Crosslinking (CXL)?
- Improved Visual Acuity
- Decreased visual fluctuations
- Prevent need for corneal transplant after complicated/defective LASIK
What Should I Do if I’m Interested in CXL or Think I Might Need It?
- Call or email our office to set up a CXL Consultation
