Collagen Cross-Linking

Miami Eye Institute is excited to introduce a novel approach to treating patients with corneal ectasia secondary to keratoconus as well as post-LASIK complications.  Corneal collagen cross-linking (CXL) is a non-invasive treatment that involves applying a photosensitizing solution (Riboflavin) to the cornea and exposing it to the low dose of UV light.  The photosensitizer reacts with the UV light to create new collagen bonds (cross-links) throughout the cornea, therefore improving cornea’s structural integrity.

CXL is now being performed for patients with this condition in approximately 200 centers throughout the world, including roughly 25 centers in the US.  On April 18, 2016 FDA has granted approval for collagen cross-linking.

CXL is the only procedure, if performed early enough, can arrest progression of keratoconus and allow good vision to be preserved.  In advanced cases of keratoconus, the treatment may still be performed, thereby delaying the need for invasive corneal transplants and prevent further deterioration of vision.

How is the treatment done?

CXL is an office-based procedure performed under topical anesthesia and sterile conditions.  During treatment, epithelium is removed to allow absorption of the photosensitizing agent.  Next, the UV light is applied for 5 minutes with continuous administration of Riboflavin.  Once the procedure is complete, the eye is covered with a bandage contact lens and the patient is started on a regimen of antibiotic and steroid drops.  Patient is instructed to return for follow-up in 1 week.

How effective is CXL?

Many research studies have shown that CXL prevents further vision loss in over 95% of patients, with 60-70% of patients having improved vision.

How long does CXL treatment last?

Based on CXL study results of over more than a decade, the beneficial effects of CXL appear to last for a long time and there is evidence that this strengthening effect will be permanent.  There maybe an exception in young children, who undergo this procedure.

Is CXL new?

Corneal collagen cross-linking has been performed since 1998. The results and safety profile of CXL have been excellent in numerous studies throughout the world. The CXL procedure is now routinely performed on patients as young as 8 years old in Europe to prevent the progression of keratoconus.

Can CXL prevent the need for corneal transplant?

Many studies have shown that CXL can often prevent the need for a corneal transplant and allow patients to wear contact lenses or glasses more comfortably and safely again.

Does CXL need to be repeated?

In many studies, the vast majority of patients responds to a single CXL treatment and do not need to have the procedure repeated.  For the occasional patient in whom this treatment is not successful, CXL can  be repeated.

When do patients see results?

Most patients find that for the first few days after the cross-linking treatment, their vision is actually worse than it was before the procedure.  This usually goes on for roughly 2-4 weeks.  Many patients start to notice positive effects 2-3 weeks after the procedure and major improvement in vision generally takes 4-6 months.  In some studies, five years after cross-linking, patient’s vision and astigmatism are still continuing to improve.   Within a month patients are able to be refitted with contact lenses.

Who is a candidate?

Patients with known or suspected corneal ectasia  or thinning should be evaluated.  CXL may not be suitable for everyone, depending on the severity and progression of ectasia.  Dr. Inna Ozerov will perform an in-depth evaluation and decide if CXL is a good treatment option.