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Corneal Collagen Cross-Linking (CXL)

Keratoconus is a degenerative condition affecting the cornea at the front of the eye. As a result of changes to the cornea, the corneal shape progressively becomes more cone-like. This results in poor focusing of light and reduced vision. The assessment includes Pentacam Corneal analysis of the shape of your cornea.

Risk factors

  • Eye rubbing
  • Allergic eye disease
  • Some genetic diseases such as Downs Syndrome

Treatment

  • Early keratoconus: Reduced vision can be normalised with glasses or contact lenses.
  • Progressing keratoconus: If keratoconus continues to progress, a treatment called corneal collagen cross-linking (CXL) is advised to prevent worsening. CXL is aimed at stabilizing the keratoconus. The extent and progression of any keratoconus can be determined using an eye scan known as corneal topography. This assesses the shape of the cornea.
  • Late keratoconus: In advanced keratoconus, either contact lenses cannot fit the corneal shape or the cornea becomes scarred. Both these situations result in poor vision. In these cases, corneal transplantation is offered to improve vision and enable contact lens wear.

Corneal collagen cross-linking (CXL) treatment

This treatment is aimed at preventing the progression of keratoconus and hence the need for a corneal transplant.

CXL is an outpatient local anaesthetic treatment to stabilise the progression of Keratoconus.

The treatment results in binding and strengthening of the collagen fibres.

A small scratch is made on the cornea and riboflavin drops are dropped onto the eye for ten minutes to soak into the cornea. The surgeon then applies ultraviolet light using a special machine called a crosslinker. The action of the riboflavin with the UV light and the collagen fibres is to bind them together.

This process takes about an hour.

The procedure is pain-free, but during the first 24hrs, there is some discomfort; therefore, the patient is the given eye drops to relieve this and often a clear bandage contact lens. It takes about a month for the surface to fully heal and settle.

Potential risks of CXL

The benefits of CXL outweigh the risks in progressive keratoconus. The rare risks include corneal infection and corneal haze.

Post-procedure treatment

It is advisable to take a few days off after the procedure to enable recovery. Contact lens use can be resumed once the corneal epithelium has healed. Antibiotic eye drops, anti-inflammatory drops and lubricant eye drops are given after the procedure.

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