Crosslinking surgery for keratoconus

Crosslinking surgery is the procedure used for patients with Keratoconus, a disorder in which the cornea is deformed.

What does the Crosslinking surgery involve?

Until recently, keratoconus patients had no treatment options available. The surgical treatment of choice for keratoconus is called Crosslinking. The method used is photooxidative crosslinking with riboflavin via the transepithelial process. This treatment increases the mechanical strength of the cornea by creating new bonds between the collagen fibers in the corneal structure which slows down the deformation of the cornea (stops the progression of the disease) and generally improves visual acuity. Corneal Cross-Linking (CXL) surgery is a procedure designed to stop the progression of the disease. It has emerged as a replacement treatment for corneal transplant surgery. It is a minimally invasive surgical treatment using the combined effect of vitamin B2 and ultraviolet rays.

It is performed under local anesthesia with drops. A device is placed to keep the eye open and riboflavin (vitamin B2) drops are administered which penetrate to the deeper layers. The patient will be placed under the UV-A lamp for about 30 minutes and at the end a therapeutic contact lens is applied. Results are maintained for at least 10 years after treatment, but regular check-up is required.

In Dr. Holhoș clinics we use Vega CBM-X-Linker devices, which allow the photooxidative Cross-Linking procedure with riboflavin to be performed without removing the corneal epithelium. The devices are equipped with an integrated video camera and the possibility of on-screen guidance.

Transepithelial cross-linking is currently the only minimally invasive procedure that can stabilize the cornea and stop disease progression. Results are better if the intervention is performed in the early stages of the disease. The procedure is comfortable, painless and has low postoperative risk. It is an outpatient procedure that usually takes about an hour.

What to expect after Crosslinking surgery?

After the procedure, a special contact lens will be placed on the eye to reduce discomfort and facilitate healing. Topical antibiotic and anti-inflammatory drops will be prescribed.

Studies have found that most patients will remain stable or achieve an improvement in corneal shape, which is very significant for people with progressive keratoconus, which could otherwise lead to severe vision loss.

It is possible to experience:

  • an increased sensitivity to light
  • poorer vision for about 1-3 months after surgery
  • general discomfort in the affected eye, some patients describe this discomfort as a burning sensation.

After crosslinking surgery, you may need new glasses or contact lenses. If you experience more severe pain, contact your doctor immediately.

What complications can occur after Crosslinking surgery?

As with any surgical procedure, there are risks associated with this surgery.

Because crosslinking surgery includes removal of the corneal epithelium (the thin layer on the surface of the cornea), risks can include epithelial haze, corneal epithelial defect (surface cell disruption) and delayed epithelial healing.

Other risks may include:

  • infectious keratitis
  • corneal opacity
  • decreased visual acuity
  • blurred vision
  • stromal scarring and corneal striae (appearance of fine white lines in the visual field)
  • ulcerative keratitis or severe inflammation of the eye is another potential side effect.

Crosslinking surgery is associated with a low rate of risks and complications.

What are the specialist's recommendations after the surgery?

Here’s what you need to know in order to take care of your eyes:

  • You may feel discomfort for a few days.
  • Your doctor will put a contact lens in your eye to help it heal.
  • It is important not to rub your eyes for 5 days after the procedure.
  • You may have sensitivity to light.
  • You should wait one to three days after surgery before starting any sports
  • To prevent infection, you may need to wait up to two weeks after surgery, or until your doctor advises otherwise, before using lotions, creams or make-up around the eye.
  • Do not rub your eye at all, just dab gently under the eye
  • Showers and baths are possible, but avoid getting water in your eye
  • You can return to work and your normal daily routine the day after the surgery
Text medically reviewed by Dr. Teodor Holhoș, Ophthalmic Surgeon
Written by Dr. Holhos Team
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