Glenpoint Centre East 300 Frank W. Burr Blvd. Teaneck, New Jersey, 07666

201-692-9434

CORNEAL COLLAGEN CROSSLINKING

Click above title to read the recently published paper authored by Dr. Peter Hersh, medical monitor of the U.S. crosslinking clinical trials. 

Click here to read Dr. Hersh's new ebook, a compilation of his published articles on Corneal Collagen Crosslinking

Collagen Crosslinking for Keratoconus Approved:  As lead author and medical monitor of the U.S. clinical trials of crosslinking, Dr. Peter Hersh played a central role in crosslinking approval.  At the CLEI Center for Keratoconus, we started the crosslinking procedure in February 2008.  We thank our many patients who participated in the study and are grateful that this important procedure will now be more widely available to keratoconus patients.  If you have any questions, please contact us at 201-883-0505 or email info@vision-institute.com.


 

 

CORNEAL COLLAGEN CROSSLINKING (CXL) BACKGROUND

Keratoconus

 

Here at the CLEI Center for Keratoconus, we have been performing crosslinking for almost years, having started in February 2008,  and have performed over 1000 treatments. Over this time, we have found CXL to be extremely valuable in the treatment of many keratoconus patients.  It is the only treatment that can help decrease the progression of KC. Collagen crosslinking uses riboflavin (Vitamin B2), a photoactive compound, in conjuction with ultraviolet light (UVA 365nm). The intereaction of riboflavin with the UV light causes a photobiologic reaction in the cornea leading to formation of molecular bonds.  Via this interaction, the primary goal of collagen crosslinking in the keratoconic patient is to strengthen and stiffen the corneal fibers (much like placing additional cables on a bridge to help support it)  in order to decrease the progression of keratoconus, and to decrease the cone steepness in some patients.

 

         Molecular Crosslinks               Corneal  Collagen Fibers                      Corneal Collagen  "Pancakes"

 

THE CROSSLINKING PROCEDURE

 CXL is performed at the state of the art CLEI Center for Keratoconus by Dr. Peter Hersh. Anesthesia drops keep you comfortable and a lid retainer prevents you from blinking. In most cases, the surface epithelial cells of the cornea are then removed and riboflavin drops are administered for 30 minutes. The riboflavin acts both to enhance the crosslinking effect and to protect the rest of the eye from the UV exposure.

        Riboflavin drops                 UV device aligned                         Crosslinking

The ultraviolet light source is then aligned and you will then look up at it with continued addition of riboflavin drops for the remainder of the procedure.  At the conclusion of the procedure, a soft contact lens bandage is applied to keep the eye comfortable and to protect the surface of the cornea during the healing process. The contact lens is left in place to improve healing for approximately 4-5 days and is then removed in the office.   Antibiotic and anti-inflammatory drops are used for approximately two weeks afterwards.

What to Expect after Crosslinking

The first phase of healing is the early period 1-5 days when the surface epithelial cells heal.  Generally, a bandage contact lens will protect the cornea and make it comfortable during this time.  However, there may be some discomfort for which we will give you appropiate medication.  You will be able to see through the lens, but vision will be hazy during this time (like driving with a foggy windshield).  In some patients, vision may continue to be mildly hazy for several months, but, in general, most patients note a return to their baseline vision over the first few weeks. Contact lenses can be restarted after we are satified with the early healing, usually around 1 month after the procedure.  Remember, collagen crosslinking is designed to decrease the progression of keratoconus and corneal ectasia.  It is not meant to improve your vision.  There are other procedures that can be used to further improve your vision.  It is important to know that, although crosslinking has been shown to be successful in most patients, it may not work in all cases and keratoconus may still continue to progress.

 

Who Should Get Crosslinking?

Not every keratoconus patient requires corneal crosslinking.  The primary goal of CXL is to decrease further keratoconic corneal distortion.  Some patients are already stable and would not need crosslinking.  There are other keratoconus patients (around 25%) who may respond particularly well, with improved vision and corneal contours.  We have done a study to determine who are the best candidates as described in the video below.

If you have an interest or have any questions about collagen crosslinking or other keratoconus treatments, please call our office at 201-883-0505 or email info@vision-institute.com.