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Moving the Corneal Cross-Linking Procedure from the OR to the Slit Lamp

A typical corneal cross-linking (CXL) procedure is performed in the operating room – but as Prof. Farhad Hafezi writes in Cataract and Refractive Surgery Today, this costs time and money. 

CXL is a surgical technique, and like most surgical procedures, corneal cross-linking procedures are performed in an operating room (OR). ORs need to be booked in advance, require extensive cleaning and sterilization before every procedure to give the surgeon a sterile environment. For these reasons, corneal cross-linking procedures carry both an organizational overhead, as well as the cost burdens associated with using an OR.

But CXL not only strengthens the cornea; it also sterilizes it. Accordingly, Prof. Hafezi and his team made a simple proposal: perform CXL at the slit lamp (in the doctor’s office), not the OR. In the article, he explains the steps he had to take to demonstrate to the world that CXL at the slit lamp is not only safe and effective but also practical.

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The questions people asked were threefold:

1. Is there a risk of corneal infection?

No, the UV light interacting with riboflavin produces reactive oxygen species. This not only cross-links (binds) the structural molecules in the cornea together, it also attacks and kills the cell walls and nucleic acids of pathogens, killing them (much like immune cells do). The cornea is left sterile at the end of the procedure, and antibiotics are given immediately afterward.

2. Isn’t the procedure too long to have a person sit at the slit lamp for all that time?

It is true that the classic “Dresden protocol” CXL protocol requires 30 minutes of illumination, which is a long time to be sat at the slit lamp. However, because of a phenomenon of “reciprocity”, if you triple the intensity of illumination, you can cut the duration to just 10 minutes – and it is still just as safe and effective as the original half-hour long protocol.

3. If people are sitting upright in a chair in the office, rather than lying down in the chair, does that mean that the riboflavin that is inside the cornea will settle to the bottom of the eye?

No. The experiments performed by Prof. Hafezi’s research team have shown no significant settling or shift in riboflavin concentration in the stroma, even after 1 hour of sitting upright after saturation.

There’s a second, great advantage to performing cross-linking procedures outside of the OR. Cross-linking’s sterilizing effect can be used to treat corneal infections, in a process called photoactivated chromophore for keratitis CXL (PACK-CXL). It’s less than ideal to bring an infection into an operating room, as it places a big burden on the staff to eradicate the pathological organism from the room afterward. But if CXL can be performed outside of the OR, either at the slit lamp or in a supine position, then this makes life easier. In the article, Prof. Hafezi explores the potential of PACK-CXL at the slit lamp to completely change how corneal infections, also known as “infectious keratitis”, are treated.

To read the full article, click here, or to see the PDF, click here.

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Augeninstitut ELZA
4.8
Based on 109 reviews
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mike
mike
09:02 04 Jan 23
Overall as a 50 year old, who wanted to continue to avoid wearing glasses and/or contact lenses, my goal was 100%... achieved with ELZA and Dr. Hafezi. I greatly appreciated the overall approach by Dr. Hafezi and his friendly and competent team in reviewing my vision at the start and following a comprehensive eye exam- the explanations of my options. For me I chose PRK in one eye for a monovision solution to correct short sightedness which was becoming more prevalent in night driving and sports such as skiing and cycling. PRK heals slowly but the outcome is worth the wait- and the cost- you use your eyes every waking moment- and for me I cannot see any reason not to pursue better vision with the ELZA team! A great quality of life enhancement!read more
Zuzana Fecko
Zuzana Fecko
21:48 31 Oct 22
Thank you so much, Dr. Torres and prof. Hafezi. 26 years I was only “dreaming” about the eye surgery due to possible... complications. I was worried ..Thank you for encouraging me to make a decision and thank you for your professionalism, explanations and great work!I wish you all the best, lots of success and only happy patients!read more
Serena Fazio
Serena Fazio
11:15 06 Mar 22
I have been to the ELZA clinic to have surgery for my miopy, as my eyes were rejecting the contacts and I was tired of... wearing glasses. From the first preliminary visit, to the actual surgery and post-surgery care Dr. Hafezi and all his collaborators have been extremely professional, considerate and helpful. All the steps of the (very short!) surgery were thoroughly explained to me in order to be as calm as possible, together with the medication plan and precautions to be aware of so that my eyes could heal in the best way possible. By following their exact instructions, the healing process has been very successful and smooth, and after about one week I was able to see perfectly. I absolutely recommend this team and their expertise!read more
Robin A
Robin A
11:43 16 Feb 22
Top experts and professional team. Highly recommended
Thunder Shiviah
Thunder Shiviah
14:05 23 Nov 21
After some research on local options I decided to go with ELZA since it stood out as the best. The operation and the... post-operation recovery went extremely smooth (something I was worried about with PRK). Now my vision is much better than I had hoped and I have no side effects such as dry eye or night vision problems. Thank you!read more
Thomas S.
Thomas S.
09:37 07 Jul 21
My left eye had to be operated on because of a cataract. As I had an Artiflex lens implanted a few years ago, it had to... be removed first before a modern lens could be implanted to correct the cataract. Prof. Hafezi treated me in an very competent and friendly manner. I am very happy with the result.read more
Selma A. Rahim
Selma A. Rahim
19:45 02 Jul 21
Dr. Hafezi.. the KING OF CXL🤴
Gianluca Ricci
Gianluca Ricci
12:46 10 Apr 21
Great team and service!
rehaneyecare
rehaneyecare
05:36 08 Apr 21
Excellent surgeon
Steven H.A
Steven H.A
16:13 11 Jan 21
Prof. F. Hafezi s expertise is enormous and he has a very pleasant and calm nature which gives the patient... security.Thank youread more
Online Commande
Online Commande
09:19 05 Dec 20
Totally creepy, very arrogant Prof.He just want your money.It may explain, why this Prof. is not in the center of the... city of Zürich and why he has been thrown away from University of Geneva.read more
Elena Churilova
Elena Churilova
10:06 17 Nov 20
At the moment, 3 months have passed since the moment I made laser vision correction in this clinic. and I can say that... I am happy that I chose this particular clinic and Prof. F. Hafezi. The entire staff of the clinic is very friendly, treats patients with sympathy and patience if they are nervous before surgery (my big gratitude to Aida Alili for all support and patience). The doctor Hafezi and other doctors of the clinic are very professional and ready to explain to you as many times as you need. I can only recommend!read more
Michele Aggiato
Michele Aggiato
18:17 10 Jan 20
The day I had Prof Hafezi checking my keratoconus I knew I was finally in the right place after years of searching for... a good ophthalmologist. Prof Hafezi recommended a surgery due to a drastic degeneration of my cornea. The surgery was performed by himself with the assistance of Dr Rodriguez, one more collaborator of Prof Hafezi’s team who got my full trust.read more
Ashley Faulkes
Ashley Faulkes
15:30 21 Mar 16
Professor Hafezi and the team at the ELZA Institute have done an amazing job of creating a first class eye clinic, with... cutting edge technology and support. I went there for a dry eye issue and other issues with my prescription, and they were easily able to help me and put me on the road to better vision! High recommend them to anyone in the Zurich/Aargau area.read more
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Augeninstitut ELZA
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