Cross-linking in Keratoconus

Keratoconus softens the corneal tissue. These changes are caused by a pathological reduction of cross-links, the chemical bonds that keep the collagen molecules bound together, in the cornea.

Cross-Links

In fact, the connective tissue across all of our bodies are held together by cross-links: it’s what gives bodily tissue mechanical strength. We know a lot more about these cross-links today than we did 20 years ago. For example, the number of cross-links increases with age – explaining why our bodies get stiffer in their old age. This is likely to be the same reason classical keratoconus stops progressing later in life: the cornea becomes naturally cross-linked with age.

 

Keratoconus = reduced number of cross-links

In keratoconus, the number of cross-links is reduced as a result of the disease, and this reduces the biomechanical strength of the cornea – or in other words, weakens it. The cornea becomes thinner and thinner, making it less able to contain the pressure inside the eye, making the cornea bulges slowly forwards, eventually assuming a cone-shaped form.

 

Cross-Linking in Keratoconus (CXL)

Cross-linking a keratoconic cornea dramatically increases the number of cross-links in the cornea. Within a few hours, the biomechanical strength of the cornea increases by 450%. There’s a great deal of clinical experience with CXL – the first procedure was performed in 1999 (more than 20 years ago) and there has been over 2,000 peer-reviewed papers on this procedure in the manuscript to date.

CXL can be performed at any age, but we perform it most often in people aged between 6 and 60 years.

Play Video

Procedure

CXL treatment is divided into 3 steps: saturation of the cornea with riboflavin, UV irradiation and postoperative follow-up.

Stage 1:
Saturation of the cornea with vitamin B2 (Riboflavin)

Because vitamin B2 is a large molecule, it can not easily penetrate the cornea. In classic cross-linking (i.e., the Dresden protocol) we remove around 8 mm (diameter) of the sealing layer of the cornea, the epithelium. This can be done manually, by means of an EBK (Epi-Bowman keratectomy) blade or with the excimer laser. Sometimes, we also perform an epi-on CXL.

Stage 2:
Irradiation with UV-A
 

This step is completely painless. Depending on the age, intensity of the disease, corneal thickness, speed of progression and any other factors (IVF, planned/impending pregnancy, thyroid disorder), we may choose a different intensity for the treatment of your eye.

Stage 3:
Postoperative follow-up
 

This is extremely important because early intervention can treat any (very rare) undesirable effects immediately. Further, each person has different rates of wound healing; too intense wound healing needs to be controlled, which we are able to do.

The ELZA Institute

EN | DE

Augeninstitut ELZA
4.7
Based on 80 reviews
powered by Google
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
Next Reviews
Augeninstitut ELZA
4.7
Based on 80 reviews
powered by Google