Name of the Procedure:

Collagen Cross-Linking (CXL) Also known as Corneal Cross-Linking or Corneal Collagen Cross-Linking.

Summary

Collagen Cross-Linking is a minimally invasive procedure designed to strengthen the cornea—the transparent front part of the eye—by increasing the collagen cross-links within it. This is typically performed to halt the progression of corneal diseases that lead to thinning and bulging.

Purpose

Collagen Cross-Linking aims to treat keratoconus and other corneal ectasia conditions, which cause the cornea to thin and distort in shape, negatively affecting vision. The primary goal is to stabilize the cornea, thereby halting the progression of the disease and preserving the patient's vision.

Indications

• Progressive keratoconus
• Corneal ectasia following refractive surgery
• Patients who exhibit a significant deterioration in corneal shape or thickness

Preparation

• Patients may need to discontinue the use of contact lenses for a specific time before the procedure.
• Pre-procedure diagnostic tests such as corneal topography, pachymetry, and slit-lamp examination.
• Instructions to avoid certain medications or substances as advised by the doctor.

Procedure Description

1. The patient's eye is numbed using topical anesthetic drops.
2. The epithelium (outer layer of the cornea) may be removed to ensure better absorption of riboflavin drops.
3. Riboflavin (vitamin B2) drops are applied to the cornea for about 30 minutes.
4. The cornea is then exposed to UVA light for another 30 minutes, which activates the riboflavin.
5. The combination of riboflavin and UVA light causes the collagen fibers to form strong chemical bonds (cross-links).

Duration

The entire procedure typically takes about an hour, with 30 minutes for riboflavin absorption and 30 minutes for UVA light exposure.

Setting

Collagen Cross-Linking is usually performed in an outpatient clinic equipped with the necessary eye care technology.

Personnel

• Ophthalmologist specialized in corneal procedures
• Ophthalmic nurses and technicians

Risks and Complications

• Temporary eye discomfort or pain
• Risk of infection
• Haze in the cornea
• Rarely, worsening of vision Most complications can be managed with appropriate post-procedure care.

Benefits

• Stabilizes the cornea and prevents further deterioration
• May improve vision or halt vision loss
• Reduction in the need for corneal transplants

Recovery

• Patients may experience mild discomfort or a gritty feeling in the eyes for a few days.
• Eye drops (antibiotic and anti-inflammatory) should be used as prescribed.
• Protective eyewear and avoidance of eye rubbing are recommended.
• Vision may be blurry for a few weeks, but typically stabilizes and improves within 3 to 6 months.
• Follow-up appointments to monitor healing and corneal stability.

Alternatives

• Rigid gas permeable contact lenses
• Intracorneal ring segments (ICRS)
• Corneal transplant in advanced cases
• Each alternative has its own risks and benefits, often discussed with the doctor to determine the most suitable option.

Patient Experience

Patients may feel slight discomfort during the procedure but usually experience mild to moderate pain once the anesthesia wears off. Pain management may include over-the-counter pain relief medications. Most report significant improvement in vision stability over time, although the full benefits can take several months to be realized.