Corneal Collagen CrossLinking with Riboflavin
(also known as С3-R ,UVX and now CXL)
A new hope for Keratoconus patients>
There is finally some good news for patients with keratoconus
Corneal Collagen Cross-linking using Riboflavin involves application of Riboflavin drops to the cornea, followed by exposure of the cornea to low dose ultraviolet A light. The activated riboflavin induces collagen fibrils (glue that holds the body together) to thicken, stiffen, & re-attach i.e. cross-link to each other creating new bonds between the adjacent collagen molecules leading to increase in the rigidity and thereby rendering cornea less malleable.
Keratoconus, a ectatic corneal disease usually progresses in the younger age group
Earlier ,the only way to make the patient see better was by fitting special contact lenses, intracorneal rings or if all else failed a lamellar or full thickness corneal transplant.
These surgical treatments have their limitations and need for lifelong care and follow up.
This is the only procedure which eventually stops/ delays the progression of Corneal ectasia and this helps in stable fitting for Contact lenses and glasses and most importantly to delay and in come cases avoid a corneal transplant.
At Retina Foundation we have the longest experience with this procedure since 2007 .
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Advantages of CrossLinking Treatment with Riboflavin
Collagen cross-linking is a new treatment for keratoconus, which uses a photosensitizing agent, riboflavin (vitamin B2) & ultraviolet light (UVA, 365nm) exposure. Ultraviolet light is used to promote increased cross-linking between collagen fibres within the cornea. The 3 & 5 year results of Dresden clinical study in human eyes has shown arrest of progression of keratoconus in all treated eyes. (Wollensak G. Crosslinking treatment of progressive keratoconus: New Hope. Current Opinion in Ophthalmology 2006,17. 356360)
How is the treatment done ?
The treatment is performed under topical anesthesia. The skin (epithelium) of the surface of the cornea is partially scratched, followed by application of Riboflavin eye drops for 30 minutes. The eye is then exposed to UVA light for 30 minutes. After the treatment, antibtotic ointment is applied and an eye-pad is worn overnight until the next day when the surface of the eye has healed. Oral analgesics are required for the first 1-2 days.
Is Ultraviolet light harmful ?
Ultraviolet A light used in this procedure is not harmful Io the eye in measured doses. The Light emitting diodes used In the 3C-R device Is of a wavelength that is not harmful, Furthermore, light emission is carefully measured and calibrated prior to each treatment.
How often will I need to be followed ?
You will be seen soon after the procedure to remove the contact lens and you will remain on eye drops for a few weeks. You will be seen at 1 month, 3 months, 6 months and one year. Following this it Is important that you be seen
on an annual basis
When can I wear contact lenses again ?
You may return to wearing lenses after one month. Your lenses may need to be changed if your comea changes shape.
How long does it take for the procedure to work ?
Cross-linking takes place as a result of exposure to Utraviolet light. The cornea increases in rigidity soon after the procedure although the process of a few days afterwards. The effect en coneal shape takes longer but flattening does not occur in all eyes that have had treatment. A satisfaction result will be arresting the progress of keratoconus.
How is corneal collagen cross lin different from other treatments ?
Strengthening the ccrnea by cross-linking its building blocks (collagen) car arrest progression of Keratoconus and has also been reported to partially reverse the corneal steepening that has already taken place. Other treatment options only address on visid rehabilitation not the actual cause of disease.