What is CXL?

Corneal cross-linking (CXL) is a treatment for patients with keratoconus which can prevent their condition getting worse. Keratoconus gets worse because the cornea weakens and bulges forward. CXL, also known as C3R, uses ultraviolet light and vitamin B2 (riboflavin) drops to stiffen the cornea. Used together, they cause fibers within the cornea to cross-link – or bond more tightly.

Which patients usually benefit from CXL?

The C3R treatment is recommended usually for patients whose corneal shape scans show that their keratoconus is progressing, or for those who are at particularly high risk of worsening keratoconus. Keratoconus usually stops getting worse by the mid-30s to 40s due to natural cross-linking with age. So CXL is not normally recommended for older patients, unless they show signs and symptoms of progression.

Who is a candidate for Crosslinking?

Patients that are good candidates for Crosslinking:

  • Have been diagnosed with worsening Keratoconus or corneal Ectasia
  • Do not have corneal scarring
  • Do not have excessively thin or steep corneas
  • Are not pregnant or nursing

Is there evidence that it works?

Collagen cross-linking is the only treatment currently available that appears to stop keratoconus from getting worse. Evidence from three randomized clinical trials one year after CXL showed success in halting keratoconus progression in more than 90% of treated eyes, with more than 45% of eyes also order ativan pills. Longer term results (up to five years) from a different study suggest a similarly high success rate in preventing keratoconus progression.

How is C3R / CXL performed?

CXL is performed as a day-care procedure by our ophthalmic surgeon. The procedure takes between 15 – 60 minutes Anesthetic drops are used to numb the surface of the eye before a small clip is placed to keep your eyelids open. The surface layer of the cornea (epithelium) is gently dissolved and brushed clear and riboflavin drops are applied every few minutes for at least 10 – 20 minutes. Following this, the ultraviolet light from a special lamp is directed at the eye for a specified duration. A soft ‘bandage’ contact lens is placed at the end of the procedure.

What happens after CXL?

You will be given eye drops to use after the procedure. The soft ‘bandage’ contact lens will remain in your eye until the surface has healed (about 5-7 days). If the bandage lens falls out during this time, please throw it away – do not attempt to reinsert it. The anaesthetic drops will wear off later on the day of your procedure, and your eye will be gritty, red and sensitive to light for few days. It is normal to experience fluctuating pain within the first two days after surgery. Everyone’s threshold for pain is different, with some patients reporting very little discomfort and others describing the first few days as very painful. Your eyes could be light sensitive and many patients find sunglasses helpful. Your vision will be quite blurred at first, but will clear gradually over the next few weeks and continue to clear over 2-3 months.

Can both eyes be operated together?

Yes. If you need CXL for both eyes, we can offer you treatment for both eyes at the same time. However we prefer to operate one eye at a time so that as a patient you are comfortable managing one sore eye or blurred eye at a time, and continue to function normally with the other eye. By the time the first eye recovers you may decide to opt for the procedure in the second eye.

Do I need to take time off from work?

Yes. You should allow at least one week off while most of the surface healing occurs, or two weeks if your job involves a lot of computer work and the treatment is being done on your better eye. You will be putting eye drops in every hour for the first day, and then every four hours for the following days. Day to day activities such as watching TV or using a computer will not do any damage to your eye, but you might find it more comfortable to rest with your eyes closed for the first few days. You will be given an appointment 1 day, 1 week and 1 month after the procedure to check the healing of your eye.

What should I do, or not do, after CXL?

It is important to put the eye drops in regularly as prescribed.

Avoid a head bath or face wash for at least a week.

Avoid getting dust or water in your eyes.

You may exercise, but should not swim before the surface of your eye has healed.

It is normally safe to resume contact lens wear after a month once the eye surface has healed.

What are the risks of CXL?

In general, CXL is very safe, but like all operations your eye needs time to heal and problems do occasionally occur. About 1-3% of patients may lose some vision in the treated eye as a result of haze, scarring, corneal surface shape irregularity or infection. In most cases, this visual loss is potentially reversible with a corneal transplant. Without CXL treatment, at least 20% of all patients with keratoconus will eventually require a corneal transplant.