FAQ Cross-linking

General

We have one of the longest experiences worldwide: since 2002, members of the ELZA Institute have been instrumental in introducing CXL technology into clinical practice. ELZA member Farhad Hafezi has published more than 70 scientific papers on CXL so far and is considered a pioneer of this method. In 2014, he was honored with the ARVO’s prestigious Carl Camras Award for Translational Research, the Association for Research on Vision and Ophthalmology, for his research in this field.

Prof. Hafezi co-founded the international Cross-Linking Congress and co-organized it since its inception in 2006. He is the publisher of the most comprehensive textbook on the CXL: “Corneal Cross-Linking” by Slack, Inc, New York.

In addition to scientific expertise, patients from all continents are treated at the ELZA Institute using the latest scientifically proven CXL technique.

Members of the ELZA Institute were the first to use CXL in the postoperative treatment of ectasia after LASIK / PRK, in very thin corneas and for infectious keratitis.

Cross-linking is a method of mechanically stabilizing the cornea.

No. Cross-linking has been used clinically in other areas of medicine since the 1980s (orthopedic surgery, ear, nose and throat surgery, cardiac surgery). In ophthalmology, CXL has been performed since 2001.

The CXL treatment for keratoconus is used in over 160 countries, including the EU and the US. The world’s longest experience exists in Dresden and Zurich. CXL is now considered the gold standard for stopping keratoconus.

Cross-linking leads to an increased number of crosslinks between the collagen fibers of connective tissue of the cornea. This can be compared to a network which receives additional elements and thereby becomes more mechanically stable.

Yes. Crosslinking of the cornea is achieved through a combination of UVA radiation and riboflavin eye drops (Vitamin B2). The intensity of the radiation was already determined 20 years ago in numerous experiments, so that no deep eye structures can be damaged. The method has been used clinically since 2001 and Farhad Hafezi from the ELZA Institute is one of the world’s most experienced CXL experts.

The greatest risk is corneal infection in the first few days after cross-linking. But this is minimized by antibiotics after surgery. This risk is less than 0.1% for us.

Scientific publications show that CXL has a high safety profile in children, comparable to that of adults.

The costs of cross-linking in Switzerland are not yet covered by the Health insurance. Most other European countries refund the cost of a CXL from the primary care.

No child or teenager will be rejected by us because the financial means for treatment are missing. We will help to find a solution.

Patients from abroad

If we receive enough information from you prior to the examination, the examination may take place on the morning of the operation and the operation in the afternoon. Often patients from abroad arrive on Sunday. We then do the examination on Monday mornings, the surgery on Monday afternoon and see you every day until Friday. You can leave on Saturday.

Yes, this is possible in principle. But after the operation you should stay in Switzerland not for five days, but seven days.

No, this is not necessary. You can stay in a hotel near us and then come to the after-checks every day. We work with a number of nearby hotels and are happy to help.

You can pay in cash, by bank transfer or credit card. Please understand that we will ask that the sum be paid before the operation.

The preliminary exam

It is essential that you do not wear your contact lenses for two weeks before the appointment. Only then can we accurately measure the extent of keratoconus and make a statement as to whether the keratoconus is progressive. And this is the only way we can confirm after cross-linking whether the keratoconus has actually come to a standstill. We are aware that this is a long time for mostly young working people, but two weeks is already the bare minimum.

All older documents are valuable and should be collected as far as possible and brought to the examination: old prescription glasses, old corneal topographies, even old lenses.

See above. Two weeks are the absolute minimum. In principle, contact lenses should be discontinued for a full twelve weeks before the examination in order to obtain an absolutely unadulterated image of the cornea. The two weeks are the bare minimum we need to make a statement.

The cross-linking operation

The goal of the surgery is to stabilize the keratoconus. We can not reverse the disease, but we can “freeze” the current condition. In a second step, measures to improve the sight can be made later, for example special contact lenses and / or laser treatment. However, this is only possible in young adulthood.

No, that’s not necessary.

All cross-linking operations are performed by Prof. Hafezi.

The eyes are held open by a lid clamp. This is unusual for the patients, but causes no pain.

No. You will not feel pain during the operation.

A total of 45 to 60 minutes.

Yes, a CXL can be repeated. This is especially necessary if a first CXL has not led to stabilization. This happens in 3 to 10 percent of the operations. In addition, rarely a second CXL after pregnancy and an additional thyroid disease is necessary.

1 week is the shortest distance when performing the operations in a row.

It is an advantage if you are accompanied, since your vision is limited afterwards and the use of public transport may pose a risk. You should also not drive a car yourself.

No, this is not necessary.

After the Operation

After 5 days. Then the risk of infection is usually over.

Usually one week, rarely until two weeks.

In the first week you can do almost all activities, eg light fitness, jogging, being in the sun, etc., with one exception: no dirty water should reach the eye (shower water, swimming pool, lake). From a medical point of view, you can safely spend the first few days after surgery in front of a screen, but you will probably get a headache.

The controls take place daily for the first 4 days, then after 1 week, 4 weeks, 3, 6 and 12 months, then annually.

The cornea reacts very slowly. Only after 6 months can it be clearly judged whether the CXL was successful.

The first 4-5 days, the view is very blurry, then it gets better with each passing day. After about 14 days the view is about 70-80% of what they achieved before the operation. Then a fine mist appears in the view, which should not frighten you. It comes about through long-term healing and will be noticeable for a few weeks without significantly affecting you. As a rule, vision is restored after 6 months at the latest, just before surgery.

Part of the corneal surface is opened during CXL treatment. This is similar to a welder’s mask. The open cornea becomes uncomfortable for about 48 hours, with the symptoms gradually decreasing. The youngest patients treated with this protocol are 9-10 years old.

Yes, for up to 6-8 weeks. We will prescribe you artificial tears, which you can use as often as necessary.

Your vision will be blurry. However, you should be able to orient yourself in a room at any time.

This is not possible for the first week after the operation.

This is usually 7 to 10 days to 100%. If necessary, we will extend it.

Sport (except swimming) is possible after 1 week without any restrictions. Please refrain from swimming for 2 weeks. For the first 5 days please do not let shower water get in the eye, so do not wash your hair and face. Showering up to the neck is possible at any time. Make-up is possible after 1 week. Please dab at make-up removal, do not rub firm.

As a rule, contact lens wear is possible four weeks after the treatment.

Yes, absolutely for the 6 month inspection. Only then can we tell you if the cross-linking operation was successful, that is, if the keratoconus has come to a standstill.

We will give you an exact medication schedule After surgery, a bandage is not necessary because a bandage contact lens protects the eye. To protect against glare, you should wear sunglasses outside.

Above all, the bandages contact lens is for your comfort and is not necessarily medically necessary. If you should lose them, continue with the drops and, before going to bed, put some of the ointment that you have received from us on the eye. We carry out the check the following day as usual.

You can fly again from the third day after the operation. If necessary, the eye should be well moistened because of the dry cabin air.

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