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Corneal Collagen Crosslinking

Chart showing a normal eye vs one with keratoconusCorneal Collagen Crosslinking (CXL) is a technique that uses ultraviolet (UV) light and a photosensitizer called riboflavin (liquid vitamin B2) to strengthen the cornea and attempt to reduce the progression of Keratoconus (KCN) or post-LASIK ectasia.

A healthy cornea retains its shape, while patients with keratoconus or ectasia have a irreversibly thin cornea that bulges outward, leading to impaired vision. Keratoconus is thought to be progressive, meaning there is a high chance it will continue to worsen with time. Crosslinking of collagen refers to the ability of collagen fibers forming strong bonds with other fibers. In the cornea, collagen cross-linking occurs naturally with aging, which may be one reason why KCN progression is thought to slow with age.

The Crosslinking Procedure

During the Crosslinking procedure, the patient is first given numbing drops in their eye. A lid separator may be used to hold the eyelids open. Depending on the patient, the epithelial surface cells may be removed. Riboflavin (vitamin B2) drops are used to moisten the cornea until the riboflavin can be seen throughout the cornea. This usually takes 15 to 30 minutes.

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After the riboflavin is present throughout the cornea, the UV light is applied to the cornea. The UV light portion of the treatment typically lasts about 30 minutes. Various drops and medications are prescribed to assist with the healing process. A soft bandage contact lens may be placed over the cornea to aid in the healing, protecting the vulnerable cornea from wind and dust. The patient is evaluated over the next several months and beyond to not only monitor the healing response, but to watch for KCN stability during the first year after treatment. Following the procedure, eyeglasses or contact lenses may not work as well as they used to because crosslinking may change the prescription. It typically takes 4-6 weeks after the procedure before contact lenses or glasses prescriptions can be prescribed.

Variations of Corneal Crosslinking

Epithelium-Off corneal crosslinking was recently FDA-approved in the United States. Minnesota Eye Consultants offers both Full Epithelium-Off Crosslinking, as well as a variation called Partial Epithelium-Off. Please discuss with your surgeon the benefits and risks of each procedure.