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Cross-Linking

What is Corneal Cross-Linking?

Corneal cross-linking (CXL) is a treatment for a spectrum of eye diseases called corneal ectasias, the most common of which is called keratoconus.

Cross-linking stiffens the cornea and thus prevents further progression of the ectasia.

The term “ectasia” means the stretching or expansion of a tissue. This occurs as a result of the cornea becoming weakened for some reason. As the eye is pressurized, the weakened region begins to bulge outwards into a cone shape, and this causes vision to deteriorate. Ectasias like keratoconus are often progressive, which means treatment is required to strengthen the cornea and stop the disease from progressing further. The treatment is corneal cross-linking.

Need more info? The links on this page refer to ELZA pages (in English) with more detailed information on the topic.

In CXL, doctors use vitamin B2 eyedrops – riboflavin – and ultraviolet (UV) light from a cross-linking device to strengthen your cornea.

The reason why the technique is called “cross-linking” is because the UV light interacts with the riboflavin to make “reactive oxygen species” in the cornea, which immediately react with the collagen fibers in the cornea, creating chemical bonds between them, so called cross-links. This makes the corneal tissue stronger and more rigid, so that it can better resist the intraocular pressure that was causing the weak parts of the cornea to bulge. The major benefit of this approach is that until the introduction of corneal cross-linking, the only treatment option was corneal transplant surgery. This can now be avoided in all but the most severe cases.
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Cross-Linking (CXL)

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Cross-Linking on Video

Cross-Linking

What Happens During the Procedure?

First, you will receive anaesthetic eyedrops to numb your eyes. If you require an “epi-off” cross-linking, then the doctor will bring you to a slit lamp, then use a cotton swab and a solution to remove the epithelium, the top layer of the cornea. If you are receiving an “epi-on” cross-linking, then this step can be skipped. Then, your surgeon will ask you to lie back in your chair while they apply specially formulated riboflavin eyedrops, which can take between 15 and 30 minutes until it has soaked into your cornea.

Then, you’ll be brought back to the slit lamp, and have your seat adjusted to make you feel comfortable, then you simply look at the light source for what usually takes around 10-15 minutes, in an entirely painless procedure.

Corneal Cross-Linking Types

There are two types: epi-off and the epi-on.

In epi-off CXL, your ophthalmologist removes the epithelium before applying the riboflavin drops to your eye.

With epi-on CXL, your ophthalmologist loosens your epithelium with eyedrops before they put the riboflavin eyedrops in.

Who Should Get CXL?

Anyone with a progressive corneal ectasia – and all children with one. It’s important that corneal cross-linking is performed sooner, rather than later, as CXL does not typically reverse the changes to the cornea made by the disease; it simply keeps the disease from getting worse. The earlier you treat, the greater the amount of vision loss is avoided.

How to Prepare

Please note that you will be on sick leave for one week.

CXL is not normally performed with a general anaesthetic, so it is fine to eat a light meal and drink fluids beforehand. However, please don’t wear any eye make-up, mascara, perfume or aftershave on the day of the surgery.

As the procedure will affect your eyesight, you will need to bring someone with you to help you get home afterward. You won’t be allowed to drive a car yourself.

CXL performed with C-Eye Device

What Happens Afterwards?

After the procedure, here’s what you need to know to take care of your eyes:

It’s crucial to not rub your eyes and not to let any water come close to your eyes for at least 1 week after the procedure, or as long as the doctor tells you.

You will be given medication and a scheme for how and when to use them. It is important that you follow this exactly, for your comfort but more importantly for the proper and safe healing process.

You will probably experience discomfort, foreign body feeling and light sensitivity for a few days. Your eyes might even itch, burn or also hurt or produce lots of tears.

To make sure that your symptoms are just the normal reaction of your body, your doctor will do regular check-ups after the surgery.

Right after the surgery your doctor will put a contact lens in your eye to protect it and to help it heal. If it falls out, let your doctor know. Do not try to put it back in.

Your Vision After CXL

After a CXL procedure, your eyesight will be blurry at first. You may notice changes in your vision from time to time to time during the healing process. You may be more sensitive to light and have a poorer vision for about 1-3 months after the surgery.

The goal of corneal cross-linking is to slow your disease and prevent future vision problems, but in some cases, your eyesight may get better over time.

Once you’ve had corneal cross-linking, you might need new glasses or contacts.

Risks

Corneal cross-linking is a safe and effective procedure, but as with all surgical procedures, some small risks are associated with the procedure, and the recovery period afterward.

These include pain, inflammation, infection, and blurred or hazy vision in the period after surgery. However, these risks are all managed with eyedrops taken after surgery, to control pain, haze, and any infection risk.

It’s worth noting that corneal cross-linking sterilizes the cornea (the reactive oxygen species generated by the UV light interacting with the riboflavin kills pathogens), so the risk of infection is mostly concentrated in the first week after surgery, where taking the antimicrobial eyedrops is so important.

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Augeninstitut ELZA
4.8
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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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