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Corneal Cross-Linking - Know Forms Of It!

Reviewed by
Dr. Anurag Agarwal 86% (10 ratings)
MBBS, MS - Ophthalmology
Ophthalmologist, Mumbai  •  22 years experience
Corneal Cross-Linking - Know Forms Of It!

Corneal cross-linking, abbreviated as CXL, is a type outpatient surgery. This process is minimally invasive, performed for the treatment of progressive keratoconus or other similar conditions which make cornea weak. The CXL strengthens cornea and stabilizes it by linking the collagen fibers present in the cornea.

In this procedure, first of all, the outermost layer of epithelial tissue on the cornea is removed. It is followed by enrichment with riboflavin and collagen, which are activated by the application of ultraviolet light to strengthen the cornea by significantly improving its rigidity. The procedure does not take more than sixty to ninety minutes in most of the cases. For recovery, it requires some weeks of care after the procedure.

Types of CXL:

There are generally two types of CXL which are defined as follows:

  1. Epithelium-off CXL: It is the procedure in which the outer thin layer of epithelium over the cornea is removed for allowing liquid riboflavin to penetrate more easily into the corneal tissue.

  2. Epithelium-on CXL or Transepithelial CXL: It is the procedure in which the corneal epithelium is left intact, which then requires a longer "loading" time or riboflavin.

Who Should opt for CXL?

CXL is most effective when performed before cornea becomes too conical or irregular in shape, or loss of vision from other causes of corneal ectasia or keratoconus. If performed at an early stage, CXL stabilizes and sometimes improves the shape of cornea, resulting in better vision and improved the ability to wear lenses.

CXL is also performed to treat corneal ulcers which no more respond to topical antibiotics. It also eradicates a number of corneal infections. CXL is a very suitable option for those who experience fluctuations in vision daily. Those who wish to get LASIK done might also be pre-treated with CXL to provide strength to the surface of the eye. CXL might help the patient avoid major corneal transplant surgery.

Preparation for CXL:

  1. Stop wearing contact lenses at least two weeks prior to the procedure.

  2. Follow the instructions of the doctor and the medical team carefully.

During the CXL:

  1. If epithelial-off CXL is being performed, the surgeon would place the patient in a reclining position to remove epithelial layer from cornea followed by addition of riboflavin eye drops.

  2. If epithelial-on CXL is being performed, the patient is placed in a reclining position, to start riboflavin drops. After some time, the eye would be checked to ensure that the sufficient riboflavin present in the cornea.

  3. The thickness of the cornea would be checked, followed by the application of the UV light for up to thirty minutes.

  4. A bandage contact lens might be placed in some cases.  Anti-inflammatory drops or topical antibiotic might also be prescribed.

After the CXL:

  1. Do not rub eyes for first five days post the procedure.

  2. Sensitivity to light might be experienced for a few weeks.

  3. Contact doctor immediately if the eyes are paining or the vision decreases suddenly.

  4. Contact doctor immediately instead of replacing it if bandage contact lens dislodges.

Take Away:

Corneal Cross- Linking is a very safe and effective procedure to restore vision lost from keratoconus. It strengthens the collagen fiber which makeup cornea and stabilize it. However, consulting an experienced and skilled cornea specialist for further queries is always advisable.

In case you have a concern or query you can always consult an expert & get answers to your questions!
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