Collagen cross-linking of cornea, including removal of the corneal epithelium and intraoperative pachymetry, when performed (Report medication separately)
CPT4 code
Name of the Procedure:
Collagen cross-linking of the cornea (CXL), also known as corneal collagen cross-linking or riboflavin ultraviolet-A treatment.
Summary
Collagen cross-linking of the cornea is a minimally invasive procedure designed to strengthen the cornea. It involves the removal of the corneal epithelium, application of riboflavin (vitamin B2), and exposure to ultraviolet-A (UVA) light.
Purpose
Collagen cross-linking is primarily used to treat keratoconus, a condition where the cornea thins and bulges into a cone shape, causing distorted vision. The goal of the procedure is to halt the progression of keratoconus by increasing the rigidity and strength of the corneal tissue.
Indications
- Diagnosed with progressive keratoconus
- Ectasia after refractive surgery
- Corneal thinning disorders
- Other degenerative conditions of the cornea
Preparation
- Discontinuation of contact lenses several days before the procedure
- Avoiding any eye makeup on the day of the procedure
- Undergoing a comprehensive eye examination and corneal topography
- Informing the doctor about any medications or allergies
Procedure Description
- The patient is given numbing eye drops.
- The corneal epithelium is carefully removed to allow better penetration of riboflavin.
- Riboflavin eye drops are applied to the cornea for approximately 30 minutes.
- The cornea is exposed to UVA light for about 30 minutes while riboflavin application continues.
- Intraoperative pachymetry (measuring corneal thickness) is performed to ensure safety.
Duration
The entire procedure typically takes about 60 to 90 minutes.
Setting
This procedure is usually performed in an outpatient clinic or surgical center.
Personnel
- Ophthalmologist or corneal specialist
- Trained nurses or surgical technicians
Risks and Complications
- Temporary discomfort or foreign body sensation
- Infection
- Haze or cloudiness of the cornea
- Delayed epithelial healing
- Rarely, vision deterioration or corneal scarring
Benefits
- Stabilization of corneal shape
- Prevention of further vision deterioration
- Potential for some visual improvement
Recovery
- Use of antibiotic and anti-inflammatory eye drops
- Wearing a protective contact lens for a few days
- Follow-up appointments to monitor healing and corneal stability
- Avoiding water exposure to the eyes and strenuous activities for a few weeks
Alternatives
- Custom contact lenses or glasses for vision correction
- Corneal transplant (for advanced cases)
- Other surgical options like Intacs inserts
Patient Experience
Patients may experience mild pain or discomfort during the procedure. Post-procedure, some discomfort, light sensitivity, and blurriness are common but usually subside within a few days. Pain management includes the use of prescribed pain relievers and antibiotic drops.