Cross-Linking extremely thin corneas

The original Dresden protocol allows CXL to be performed safely when the thickness of the cornea is 400 μm or higher. However, in advanced cases of keratoconus, pellucid marginal degeneration and post-LASIK ectasia, the cornea may be thinner.

One way to treat such a cornea nonetheless is the use of hypo-osmolar riboflavin. This special vitamin B2 causes the cornea to absorb water and swell. This technique was developed in 2007 and published in 2009 with Prof. Hafezi as first author. Since then, this application has become a global standard.

2008: The "Birth" of CXL in ultrathin corneas

Zurich, Switzerland: A 26-year-old patient is being treated with epi-off CXL. After removal of the epithelium and application of “normal” iso-osmolar riboflavin, the corneal thickness is 325 microns; too little to do a safe CXL. In a second step, we used hypo-osmolar riboflavin. After 10 more minutes, the cornea had “swollen” to 407 microns, and the CXL could be performed safely.

The treatment of extremely thin corneas requires a lot of experience as many factors have to be considered – from how often the vitamin B2 is applied, to how long the speculum is left open. Our experience is one of the longest in the world and allows us to safely perform a CXL on thin corneas (and thicker corneas too!).

The future - the sub400 protocol

A number of strategies have been developed to treat very thin corneas since 2009. ELZA’s Medical Director, Farhad Hafezi, has helped to reivew these techniques (see posts below), including contact lens-assisted CXL (CACXL) and the Epithelial Island Technique. Which technique is chosen must be carefully considered on a case-by-case basis.

In addition, the research group led by Professor Hafezi is in charge of developing new techniques that are tailored to the individual corneal thickness. In the future it will be possible to treat corneas of less than 300 μm using CXL, without swelling the cornea first.

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Augeninstitut ELZA
4.7
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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
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Augeninstitut ELZA
4.7
Based on 80 reviews
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