Keratoconus treatment (cross-linking surgery)

How does cross-linking surgery works?

CXL – Corneal Collagen Cross - Linking or cross-linking is an innovative minimally invasive procedure that is designed to effectively treat keratoconus and other ectatic corneal diseases. The essence of the procedure is to strengthen the collagen fibers of the cornea by creating new chemical bonds between them.

The procedure is indicated for patients with advanced keratoconus, pellucid marginal corneal degeneration, iatrogenic corneal ectasia after refractive surgery, and bullous keratopathy.

The standard procedure protocol (Dresden Protocol) begins with preliminary preparation, including local anesthesia and corneal thickness measurement. After removal of the corneal epithelium in the area of 8-9 mm, corneal saturation with 0.1% riboflavin solution is performed for 30 minutes with constant monitoring of tissue saturation.

The next step is UV irradiation of the cornea with a wavelength of 370 nm and an irradiation power of 3 mW/cm². The standard irradiation duration is 30 minutes, with a total irradiation dose of 5.4 J/cm². There is also an accelerated protocol with a higher UV intensity and a reduced treatment time of 10-15 minutes, demonstrating comparable efficacy.

In the postoperative period, the patient is prescribed wearing a protective contact lens and complex local therapy, including antibacterial and anti-inflammatory drugs. Recovery is gradual: the first week is characterized by limitation of physical activity and control of epithelialization, and during the first month there is a gradual recovery of vision under the regular supervision of an ophthalmologist.

The effectiveness of the method is confirmed by statistics: it stops the progression of keratoconus in 90-95% of cases, corneal flattening by 1-2 dioptres is observed in 60-70% of patients, and improvement of visual acuity is observed in 50-60% of cases. Refractive stabilization usually occurs within 3-6 months after the procedure.

The main advantages of the method include its minimally invasive nature, high efficiency, the possibility of repeated performance, prevention of keratoplasty, rapid rehabilitation, and the possibility of out-patient execution.

Method benefits

The high efficiency of the method is confirmed by numerous clinical studies. In most cases, it is possible not only to stop the progression of keratoconus, but also to improve the shape of the cornea. This leads to stabilization, or even improvement of visual functions in patients.

One of the most important advantages of cross-linking is that the procedure can avoid or significantly delay the need for complex corneal transplant surgery. This is especially important for young patients who have been diagnosed with progressive keratoconus.

The safety of the method is ensured by a carefully developed protocol for the procedure and the use of a natural substance - riboflavin. The rehabilitation period is relatively short, and the patient can return to their usual lifestyle just a few days after the procedure.

An important advantage is the possibility of combining cross-linking with other methods of vision correction, which allows achieving optimal treatment results. If necessary, the procedure can be repeated, which provides additional opportunities to control the disease.

The affordability of the procedure is also a significant benefit, especially when compared to the cost of corneal transplant surgery. In addition, early cross-linking can significantly reduce future costs for the treatment of keratoconus complications.