Corneal cross-linking

Keratoconus and corneal cross-linking

Table of Contents

What is keratoconus?

Keratoconus is an eye condition where the front part of your eye, called the cornea, becomes thin and bulges out into a cone shape. This can make your vision blurry and sensitive to light and glare.

It usually affects both eyes and starts between the late teens and 30 years of age. In the early stages, glasses or soft contact lenses can help. Later, rigid contact lenses or other lenses may be needed. In extreme cases, a cornea transplant may be necessary.

A treatment called corneal cross-linking can slow or stop it from getting worse, and may prevent the need for a transplant.

Contact lens in keratoconus
Contact lens in a patient with keratoconus, in the image below we can see a tomography (OCT) with the cornea in the shape of a cone. All rights reserved Retina Center

What is corneal cross-linking?

Crosslinking is the only minimally invasive procedure scientifically supported to halt keratoconus progression.

This condition impacts young individuals by altering the corneal structure and gradually diminishing visual acuity in both eyes.

The aim of the treatment is to increase the rigidity of the cornea to halt the disease’s progression.

How does corneal cross-linking work?

Under topical anesthesia (eye drops), a riboflavin solution (vitamin B2) is directly applied to the cornea, which has been previously prepared by gently removing the outermost layer, or epithelium, to allow better penetration of the solution.

After the cornea is impregnated with the vitamin B2, it is exposed to low-intensity ultraviolet (UV) light (370 nm wavelength UVA light at an irradiance of 3 mW/cm2, 5.4 J/cm2 surface dose) for a period of 10 to 30 minutes depending on the type of crosslinking protocol used (Dresden Protocol or Accelerated Protocols).

The combination of UV light and riboflavin generates crosslinks (crosslinking) among the corneal collagen fibers, resulting in a stronger and more stable cornea.

Performing corneal crosslinking
Performing corneal croslinking

Advantages of Crosslinking Treatment

  • Halting the progression of keratoconus: The primary objective of crosslinking is to stabilize the cornea and prevent its shape from continuing to deform, thereby also preventing keratoconus-related blindness. The effectiveness of this procedure in stopping the progression of keratoconus is up to 90%.
  • Corneal Transplant Prevention: By halting the progression of keratoconus, the risk percentage of needing more invasive interventions in the future is reduced.
  • Improvement in Vision Acuity: In some cases, patients experience an improvement in vision related to the reshaping of the corneal structure. In some individuals, the steepest keratometry readings decrease by up to 2 diopters.

How should I prepare as a patient for the surgery?

In the preoperative consultation the cornea is evaluated with corneal topography; this study will perform detailed measurements of the cornea to assess its thickness and curvature.

It is recommended to suspend the use of contact lenses (4 weeks for rigid contact lens users, 2 weeks for soft contact lens users, and the same day for scleral contact lens users) before the corneal topography study.

With this information, the doctor evaluates if the patient is a good candidate for crosslinking surgery.

Corneal topography in keratoconus
Corneal topography. We have the best equipment to diagnose and treat keratoconus

Recommendations on the day of surgery

  • The procedure is performed under topical local anesthesia (drops), however, for your comfort, intravenous sedation is administered, therefore an 8-hour fasting period is required.
  • Do not apply makeup, lotions, perfumes the day of the surgery.
  • Wear comfortable clothing and avoid carrying jewelry or accessories.
  • Plan to have someone accompany you home after the procedure, as you will not be able to drive immediately after surgery.

Post-surgery indications

  • Antibiotic and anti-inflammatory treatment for at least 1 week after crosslinking surgery to avoid complications.
  • It is recommended to suspend the use of pools and saunas for at least 1 week after the procedure or until the doctor indicates.
  • Follow-up visits: Attend all scheduled follow-up appointments so that your doctor can monitor the healing of your eyes and the efficacy of the procedure.
  • Ocular UV light protection: Use sunglasses to protect your eyes from bright light and UV rays.
  • Warning signs: Contact your doctor immediately if you experience an increase in pain, redness, decreased vision, or any sign of infection.
Como se hace el crosslinking corneal en queratocono

Potential side effects and complications

  • Infection: As with any procedure involving an incision or opening of tissue, there is a risk of infection, although it is low (0.7%)
  • Corneal haze: A temporary haze or cloudiness in the cornea that generally resolves over time (10%)
  • Healing problems: The corneal epithelium may take time to heal, which could lead to additional complications.
  • Transitory corneal edema: Fluid accumulation in the cornea that can cause blurred vision (70%), generally resolves with anti-inflammatory treatment.
  • Changes in vision: Some patients may experience changes in their vision, including increased light sensitivity or the appearance of halos (0.04%).
  • Need for additional treatment: In some cases, the procedure may not completely halt the progression of keratoconus, and additional treatments may be needed.
  • Pain: It is common to experience discomfort or mild pain after surgery, which is treated with analgesics.

Additional information: Johns Hopkins Medicine

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