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COLLAGEN CROSS-LINKING:

Corneas with keratoconus have too few collagen bonds to maintain structural integrity. The lack of collagen bonds and subsequent weaknesses result in corneal bulging, steepening, and irregularities that can significantly affect vision.

Keratoconus is now treatable through corneal collagen cross-linking (CXL). This new, non-invasive treatment applies a photosensitizing solution containing riboflavin (vitamin B2) to the cornea and then exposes it to a low dose of ultraviolet light. The reaction between the photosensitizer and the ultraviolet light creates new collagen bonds, or cross-links, throughout the cornea.

CXL strengthens and adds resilience to affected corneas by creating new collagen bonds. If performed early enough, CXL can counteract the effects of keratoconus and preserve good vision. In more advances cases, CXL - often combined with other types of treatment - can postpone the need for invasive corneal transplants and prevent vision from deteriorating.

Treatment:

CXL is performed in a treatment room under topical anaesthesia. The procedure is uncomplicated and painless. First, the epithelium is gently rubbed off to allow for absorption of the riboflavin. Then the riboflavin drop and ultraviolet light are applied for approximately 30 minutes. The procedure is then complete, and the eye is covered with a bandage contact lens to help the epithelium grow back (normally within two to three days) and facilitate a quick visual recovery.

There is no concern regarding the safety of the ultraviolet light on the eyes. The ultraviolet light used for CXL was specifically chosen because it is safe for the cornea, lens and retina, but still sufficient to induce collagen cross-linking. Clinical studies have demonstrated that the amount of light that reaches the deeper structures in the eye is not enough to cause damage. Further, ultraviolet light is measured and calibrated prior to each treatment to ensure safe exposure levels.

Recovery:

While vision typically returns to prior levels within one week, the most dramatic improvements occur over the first three months. Then gradually, over the next 12 months, the cornea continues to stiffen and stabilize resulting in further improvements. In most cases, the keratoconus ceases to progress and, in some cases, vision improves.

Patients will usually be seen daily to assess initial healing. The bandage contact lens is then removed about 3 to 4 days after treatment. Follow up visits will be scheduled at one, three and six months and one year. Thereafter, patients will be seen annually to monitor results.

In most cases, patients may return to wearing contact lenses for their prescriptions after one month. Contacts, however, may need to be changed occasionally until the cornea fully stabilizes.

Advantages of CXL:

CXL is unique in that it is non-invasive and targets the source of the problem which is the weakened cornea due to keratoconus. The treatment significantly increases the number of collagen bonds between the corneal layers, returning the cornea to a more stable condition.

When compared with other procedures such as intrastromal ring segments or laser surgery, CXL targets the underlying cause, therefore promoting long-term benefits to patients afflicted with keratoconus. Further, CLX can be combined with Intacs before or after the procedure, and fine-tuned with surface laser treatments.

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