Your eye surgeon may recommend Corneal Cross Linking (CXL) in the treatment of Keratoconus.
In the treatment of Keratoconus or Pellucid Marginal Degeneration (PMD) the aim is to strengthen the corneal collagen by exposing it to UV light. This is achieved by soaking the corneal collagen with a green dye in the form of Riboflavin to permanently increase the structural strength of the cornea enabling it to withstand the deformation forces in the eye that lead to the cone shape distortion seen in those suffering from Keratoconus.
Each case will be different, and all expected outcomes will be discussed prior to any treatment with your surgeon and assessed with the use of specialist diagnostic devices during your initial assessments.
In mild to moderate Keratoconus, CXL can stop disease progression in virtually all eyes. Therefore, it is preferable to treat eyes before the disease produces marked difficulties with vision.
To deliver sufficient Riboflavin into the cornea, the epithelium (a layer of tissue that covers the front of the cornea and acts as a protective barrier for it) must be partially removed under topical anaesthetic drops and then applying the Riboflavin for 20-30 minutes.
Once there is sufficient Riboflavin in the cornea, 10 minutes of UV light is delivered to the cornea. This requires the eye to be open for the duration of the treatment, and an eye speculum is used for this purpose. Sensitive cells at the edge of the cornea are protected, and after completion of the treatment, drops are instilled, and a bandage contact lens is inserted to protect the regenerating epithelium.
In some eyes with mild Keratoconus and sufficient corneal thickness, it is possible to perform a therapeutic laser treatment to treat irregular astigmatism induced by the condition. Cross-linking is then performed in a routine manner immediately after.
Regarding all the above, you will have the opportunity to ask any questions to your surgeon to ensure you understand the procedure and your treatment program.
It takes 4-5 days for the epithelium (the layer of tissue that covers the front of the eye) to regenerate and a further 2-4 weeks before the vision in the eye approaches pre-operative levels. Drops are required for 6-8 weeks, and appointments with your surgeon are necessary at one, three, and nine months.
It is normal to see a reaction within the corneal collagen over the first few months characterised by a hazy appearance to the cornea of a mild degree. This is not normally noticed by the patient, but a slight loss of contrast to lights may be experienced for up to three months.
It is usually necessary to be away from work or school for 7-10 days. Once the epithelium has healed, everyday activities can commence, only being limited by the rate of visual recovery. Contact lenses can be worn again after two weeks, but it may be four weeks before this can be done comfortably.
Fortunately, complications are rare with this procedure. Infections have been reported, but since the UV light sterilises the cornea, it is very unlikely. If there is insufficient shielding of the eye by the Riboflavin, damage to the corneal endothelium may arise. However, with current protocols and technology, this is very rare. A more pronounced haze may be seen in a small number of eyes, and this can affect visual contrast under low light conditions for a longer period than anticipated; however, it is rare for this to persist. While it generally takes 4-5 days to heal, it is possible for the epithelium to take up to 10 days to recover.
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