Skip to main content

A study found that 70% of patients with fast-moving keratoconus saw their corneas flatten after corneal collagen cross-linking (CCL). This simple yet powerful treatment is changing lives for those with keratoconus. It offers hope to those facing its challenges.

Corneal collagen cross-linking, or CCL, is a new way to strengthen the cornea. It stops keratoconus, a condition that can badly affect your vision. By making the cornea stronger, CCL can help patients see better and live better lives.

Key Takeaways

  • Corneal collagen cross-linking (CCL) is a minimally invasive procedure that strengthens the cornea to halt the progression of keratoconus.
  • CCL has demonstrated promising outcomes, with studies showing that up to 70% of patients experienced flattening of their steep corneal curvatures.
  • The procedure aims to improve visual acuity and quality of life for individuals struggling with keratoconus, a progressive eye condition.
  • CCL is a relatively new treatment, with the standard Dresden protocol developed in 2003 and FDA approval granted in 2016.
  • Further research is needed to fully understand the long-term efficacy and potential risks of CCL in managing keratoconus.

Introduction to Keratoconus

Keratoconus is a condition where the cornea, the clear front of the eye, thins and bulges. This shape change can cause blurred and distorted vision. It usually starts in the teenage years or early 20s and often stops by the mid-30s.

What is Keratoconus?

Keratoconus makes the cornea thin and bulge into a cone shape. This irregular shape makes it hard for the eye to focus light. People with keratoconus often see things blurred and distorted, and are more sensitive to light and glare.

Causes and Risk Factors

The exact reasons for keratoconus are still unknown. It’s thought to be caused by a mix of genetics and environment. Known risk factors include:

  • Family history of the condition
  • Chronic eye rubbing or irritation
  • Certain medical conditions such as Down syndrome and connective tissue disorders
  • Hormonal changes or imbalances

Keratoconus is a progressive eye condition that gets worse over time if not treated. It can cause the cornea to thin and bulge, affecting vision and daily life.

“Approximately 1 in 2000 people are affected by keratoconus, a condition that leads to a gradual increase in corneal curvature and a decrease in visual acuity.”

Study Findings
Siena Eye Cross Study (2010) Reported long-term results of riboflavin ultraviolet A corneal collagen cross-linking for keratoconus in Italy, with 149 occurrences and 4% prevalence.
Randomized controlled trial (2008) Presented preliminary results of corneal collagen cross-linking in progressive keratoconus, with 24 occurrences and a 7% success rate.
Complication and failure rates study (2009) Reported 62 cases, resulting in a 1.5% failure rate after corneal crosslinking.

Understanding CCL (CORNEAL CROSS-LINKING)

Corneal cross-linking (CCL) is a new treatment that makes the cornea stronger. It uses a special photochemical reaction. This involves putting riboflavin eye drops and UV light on the cornea.

This creates bonds between collagen and proteoglycans. It’s like the cornea getting stiffer with age. This stops keratoconus, a condition that makes vision blurry.

The cornea is the clear part at the front of the eye. It bends light for clear vision. In keratoconus, the cornea gets thinner and bulges, causing blurry vision.

CCL makes the cornea stronger. It stops it from getting worse and keeps vision clear.

During CCL, the outer layer of the cornea is removed. This lets the riboflavin solution get in better. The riboflavin absorbs UV light and makes the cornea stiffer.

New methods in CCL don’t need to remove the outer layer. This is good because it lowers infection risk and speeds up healing. It also means less haze and quicker vision recovery.

Statistic Value
Corneal Cross-Linking (CCL) treatments performed at Dünyagöz Hospitals in Turkey Over 20,000
First scientific study on CCL presented at the European Cataract and Refractive Surgery Congress (ESCRS) and accepted for presentation at the American Academy of Ophthalmology (AAO) Congress Yes
CCL treatment aims to Strengthen the corneal structure and halt the progression of keratoconus disease

The corneal collagen cross-linking procedure is very promising. It can even make the cornea shape better in people with keratoconus. More research and better techniques are making this treatment safer and more effective. It gives hope to those with this serious eye condition.

Preparing for CCL Treatment

Candidacy and Evaluation

People with keratoconus that’s getting worse are often chosen for CCL treatment. Doctors check the corneal thickness, shape, and signs of progression of keratoconus to see if it’s right for them. They won’t do it if the cornea is too thin, if there’s a past eye infection, or if the eye is badly scarred.

Pre-treatment Instructions

Before the CCL treatment, patients get special drops to numb their eye. Their eye is cleaned, and the top layer of the cornea is removed. This makes the treatment work better.

Studies show the cornea can get up to 300% stronger with UVA light during the treatment. It’s best for those with irregular corneas and changing vision. It can also help those who had RK surgery and have unstable corneas.

“Corneal collagen crosslinking can stabilize and improve the shape of the cornea, enhancing visual acuity and contact lens tolerance.”

The team at Assil Gaur Eye Institute has done over 100,000 eye surgeries. They are leaders in improving CCL treatment.

The CCL Procedure

The corneal collagen cross-linking (CCL) procedure is a two-step method to stop keratoconus from getting worse. This eye condition makes the cornea thin and bulge. The process includes removing the corneal epithelium, applying riboflavin drops, and using UV light.

Epithelium Removal

The first step is to carefully remove the central 7-9 millimetres of the corneal epithelium. This is done to help the riboflavin drops reach the corneal stroma better. The corneal stroma is the middle layer of the cornea.

Riboflavin Application

After removing the epithelium, riboflavin 5-phosphate drops are put into the eye every 5 minutes for 30 minutes. This makes sure the corneal stroma is fully saturated with riboflavin.

UV Light Exposure

Once the riboflavin is absorbed, the cornea is exposed to UV-A light. The light has a wavelength of 370 nanometres and an intensity of 3 milliwatts per square centimetre for 30 minutes. The riboflavin acts as a photosensitiser, creating bonds between collagen and proteoglycans in the corneal stroma. This stiffens and strengthens the cornea, stopping keratoconus from getting worse.

Key Steps in the CCL Procedure
1. Epithelial debridement: Removal of the central 7-9 mm of the corneal epithelium
2. Riboflavin instillation: Application of riboflavin 5-phosphate drops every 5 minutes for 30 minutes
3. UV light exposure: Cornea exposed to UV-A light (370 nm, 3 mW/cm2) for 30 minutes while continuing riboflavin drops

The UV light and riboflavin instillation start a photochemical reaction. This reaction creates bonds between collagen and proteoglycans in the corneal stroma. This makes the cornea stiffer and stronger, stopping keratoconus from getting worse.

https://www.youtube.com/watch?v=5ZDCN_H3s5Q

Post-operative Care and Recovery

After having corneal cross-linking (CXL), you might face some challenges. It’s important to take good care of your eyes and follow the recovery plan closely.

Pain Management and Discomfort

Pain is common after CXL, especially in the first two days. You should take pain relief like paracetamol, Naproxen, or Ibuprofen regularly. Wearing sunglasses and staying in a dim room can also help with light sensitivity.

Eye Drop Regimen

You’ll need to use antibiotic and anti-inflammatory eye drops to heal and prevent infection. Follow the exact schedule given by your doctor, which might be hourly at first and then less often later. Some drops might stop after weeks 3 and 4, as your doctor advises.

Corneal Healing and Haze

The top layer of your cornea will grow back in 3-4 days. But, you might see haze and blurring for up to 6 months. Using artificial tears can help with any discomfort during this time.

Contact Lens Wear

You can start wearing contact lenses again about 3 months after CXL, once your cornea is fully healed.

To recover well after CXL, stick to your eye drop schedule, take pain meds as needed, and avoid rubbing your eyes or doing strenuous activities. Also, don’t wear makeup or do anything that might harm your healing eyes. Regular check-ups with your doctor are key to tracking your recovery and catching any issues early.

Statistic Value
CXL Success Rate More than 9 out of 10 cases
Progression Rates Approximately 1 out of 10 cases
Infection Risk Around 1 in 1000 cases
Scarring Risk About 1 in 1000 cases
Vision Loss Risk Potential as a rare outcome
Infection Rate Less than 1 in 100 patients

Potential Risks and Complications

Corneal cross-linking (CXL) is usually safe. But, like any surgery, it can have risks and complications. Common side effects include redness, light sensitivity, severe eye pain, dry eye, and corneal haze.

Though rare, serious complications can happen. In about 1 in 10 cases, keratoconus may get worse despite CXL. Infections, like corneal infection, are very rare, affecting 1 in 1,000 people. Corneal scarring also occurs in 1 in 1,000 patients.

In very rare cases, vision loss can happen. This is usually linked to thin corneas. A condition called endothelial decompensation can cause corneal melting in a few patients.

“Patients are advised to seek urgent medical attention if they experience increasing pain, redness, or worsening vision following a CXL procedure.”

The risks of CXL are low. But, it’s crucial for patients to know about possible complications. Following post-operative instructions carefully can help avoid most problems.

Complication Incidence Rate
Progression of Keratoconus 1 in 10 cases
Corneal Infection 1 in 1,000 cases
Corneal Scarring 1 in 1,000 cases
Vision Loss Extremely Rare
Endothelial Decompensation Extremely Rare
Corneal Melting Extremely Rare

CCL (CORNEAL CROSS-LINKING) Results and Outcomes

Corneal collagen cross-linking (CXL) is a new treatment for keratoconus. This eye condition makes the cornea thin and irregular. Studies show CXL can stop keratoconus from getting worse and even improve vision.

Halting Keratoconus Progression

More than 90% of people with keratoconus see no further worsening after CXL. The treatment strengthens the cornea. This makes the cornea stable and stops it from thinning and bending more.

People usually see the effects of CXL within a year. They are then watched for 3-5 years to make sure the cornea stays stable.

Improving Visual Acuity

CXL can also make vision better for some people. It can make the front of the cornea flatter. This can reduce eye problems and improve how well you can see.

But, it might take at least a year to see how much vision has improved. The full effect of CXL on vision is still being studied.

The results of CXL for keratoconus are very promising. It can stabilise the cornea, stop the disease from getting worse, and sometimes make vision better. As the technology gets better, CXL’s benefits are expected to grow.

“Corneal collagen cross-linking has shown to halt the progression of keratoconus over a seven-year follow-up period.”

Study Findings
Ten-year results of corneal collagen cross-linking in progressive keratoconus Showed improvements in patients
Long-term results of corneal collagen cross-linking with riboflavin and ultraviolet-A irradiation for keratoconus Indicate positive outcomes
Accelerated corneal cross-linking in paediatric patients with keratoconus Showed positive results after 24 months

Advancements and Future of CCL

Researchers are always looking to improve the corneal cross-linking (CXL) method. They’ve come up with accelerated CXL protocols. These use more intense ultraviolet (UV) light to shorten treatment time without losing effectiveness.

Another big step is transepithelial CXL. It skips the need to remove the top layer of the cornea. This makes the process less painful for patients. It’s especially good for kids and those with Down syndrome.

There’s also LASIK XTRA, which combines CXL with LASIK. This mix aims to make the cornea stronger. It could lower the chance of complications after LASIK.

Scientists are also looking into using CXL on the sclera to treat myopia. This method tries to make the sclera stiffer. It might slow down myopia’s progression and reduce the need for glasses.

The future of CXL looks bright. These new methods could lead to better treatments for keratoconus and other corneal problems. They aim to make CXL more effective, efficient, and safe. This could greatly improve patients’ lives.

“The new Ricrolin TE formula, currently marketed in Europe, is now used in about 20% of cross-linking procedures, showing an increase in its adoption.”

Advancement Description
Accelerated CXL Utilises higher UV light intensity to reduce treatment duration while maintaining efficacy
Transepithelial CXL Avoids the need for epithelial removal, making the process more comfortable for patients
LASIK XTRA Combines CXL and LASIK to enhance the stability of the cornea and address refractive errors
Scleral CXL Designed to stiffen the sclera, potentially slowing the progression of myopia

Conclusion

Corneal collagen cross-linking is a safe and effective treatment for keratoconus and other corneal issues. It strengthens the cornea by creating bonds between collagen molecules. This can stabilise the cornea and sometimes improve vision.

While there are risks like infection and scarring, most patients have good results. The technique is getting better, offering hope for those with these conditions.

Studies show that CXL can stop keratoconus from getting worse. It improves vision and corneal measurements over time. The Dresden protocol is the main treatment, but new methods are also working well.

Combining CXL with other eye treatments can lead to even better vision. This shows the potential of CXL in helping patients.

More research is needed to make CXL even better. It’s safe and can stop keratoconus from getting worse. This makes CXL a valuable treatment for many people.

FAQ

What is corneal collagen cross-linking (CXL)?

CXL is a treatment to stop corneal ectasia, like keratoconus. It uses a special chemical and UV light to strengthen the cornea. This makes the cornea stiffer.

What is keratoconus and what are its causes?

Keratoconus makes the cornea thin and cone-shaped. This blurs vision. It’s caused by genetics and environmental factors, like rubbing your eyes.

How does CXL work to treat keratoconus?

CXL uses UV light and riboflavin drops to stiffen the cornea. Riboflavin absorbs UV light, creating bonds in the cornea. This stops keratoconus from getting worse.

Who are the primary candidates for CXL treatment?

People with progressive keratoconus can get CXL. Doctors check the cornea’s thickness and shape to see if it’s right. Some can’t have it, like those with thin corneas or infections.

What happens during the CXL procedure?

The CXL procedure starts by removing the corneal surface. Then, riboflavin drops are applied every 5 minutes for 30 minutes. Next, UV-A light is used for 30 minutes, while the drops continue.

What can patients expect during the recovery period?

Patients might see blurry vision and feel pain after CXL. They should take pain meds and wear sunglasses. The eye shield protects the eye. It takes a few days for the eye to heal.

What are the potential risks and complications of CXL?

CXL is safe, but risks exist. Common side effects include redness and pain. Rare complications include infection and vision loss. Thin corneas face more risks.

What are the typical outcomes and results of CXL?

CXL stops keratoconus in over 90% of cases. It can also improve vision. The full effects take at least a year to show.

What are the latest advancements in CXL?

New CXL methods are being explored. These include faster treatments and combining CXL with LASIK. They aim to make CXL safer and more effective.

Leave a Reply