ESCRS Today looks at 25 Years of Progress in CXL

ESCRS Today: Innovations in Corneal Cross-Linking (CXL): A Look at 25 Years of Progress

A ESCRS Conference, held last week in the Fira Barcelona, provides a “show daily” newspaper, called ESCRS Today.

This year, ESCRS Today featured ELZA’s Medical Director, Prof. Farhad Hafezi, in two articles. Why?

The year 2024 marks a significant milestone in ophthalmology: the 25th anniversary of corneal cross-linking (CXL) entering clinical practice. Since its inception, CXL has transformed the treatment landscape for keratoconus and other corneal ectatic diseases. ESCRS Today’s articles delved into the origins of CXL and its evolving role in therapeutic refractive surgery.

From Serendipity to Standard of Care

In an article by Prof. Farhad Hafezi, and Drs. Mark Hillen, and Emilio Torres-Netto, the history of CXL is traced back to the innovative work of Professors Theo Seiler and Eberhard Spoerl in the 1990s. Faced with limited treatment options for corneal ectasias—where corrective lenses offered only symptomatic relief and keratoplasty was the last resort—they sought a method to halt disease progression by strengthening the corneal stroma.

Their breakthrough came from an unexpected source. Inspired by the use of ultraviolet (UV) light to harden dental resins, Seiler envisioned a similar approach for the cornea. By combining UV-A light with riboflavin (vitamin B₂) as a photosensitizer, they developed a technique to induce covalent cross-links in stromal collagen, effectively increasing corneal stiffness. This method localized the effect to the cornea, minimizing damage to surrounding tissues.

Standardizing Terminology and Protocols

The procedure, initially known by various names such as ‘corneal collagen cross-linking’ and ‘C3-R,’ was standardized as ‘corneal cross-linking (CXL)’ during the 2008 CXL Experts’ Meeting in Zurich. The ‘Dresden protocol,’ the original method of performing CXL, has stood the test of time and remains the gold standard. Long-term studies have demonstrated its efficacy in halting keratoconus progression for over 15 years.

Looking Ahead: The Future of CXL

While the traditional CXL techniques continue to be effective, the future holds promising advancements. One such innovation is two-photon CXL, utilizing femtosecond lasers to selectively cross-link corneal tissue at specific three-dimensional points. This technology could potentially expand the applications of CXL beyond ectatic diseases, possibly offering new treatments for myopia and astigmatism.

Conclusion

As we celebrate 25 years of CXL, it’s clear that the field continues to evolve. Innovations like two-photon CXL and personalized therapeutic refractive surgeries are expanding the horizons of what’s possible in corneal treatment.

Enhancing Quality of Life Through Therapeutic Refractive Surgery

In another ESCRS Today featured article, Prof. Farhad Hafezi discussed the impact of therapeutic refractive surgery on patient quality of life during the Global Refractive Summit at the 2024 ESCRS Congress in Barcelona. He emphasized the distinction between visual acuity and visual quality, advocating for treatments that address corneal aberrations to improve overall visual function.

Case Studies Highlighting Advanced Techniques

Prof. Hafezi presented several cases where advanced diagnostic and surgical techniques were employed:

  • Scar After Keratitis: By releasing traction caused by scarring and performing a wavefront-guided surface ablation, significant improvements in visual quality were achieved over 6 to 12 months.

  • Keratoconus Patients: Combining limited tissue removal through wavefront-guided surface ablation with immediate CXL strengthened the cornea without compromising structural integrity, enhancing corrected distance visual acuity (CDVA).

  • Post-PRK Complications: In patients with high horizontal coma due to outdated PRK procedures, recentering and enlarging the optical zone led to notable improvements in visual quality.

A Holistic Approach to Vision Correction

Prof. Hafezi underscored the importance of addressing both corneal structure and visual function. By leveraging advancements in diagnostic imaging and personalized treatment planning, ophthalmologists can offer solutions that significantly enhance patients’ quality of life.

O Instituto ELZA

EN | DE | PT
.
.
4.8
Como base em 109 críticas
powered by Google
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!
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!
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!
Robin A
11:43 16 Feb 22
Top experts and professional team. Highly recommended
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!
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.
Selma A. Rahim
19:45 02 Jul 21
Dr. Hafezi.. the KING OF CXL🤴
Gianluca Ricci
12:46 10 Apr 21
Great team and service!
rehaneyecare
05:36 08 Apr 21
Excellent surgeon
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 you
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.
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!
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.
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.
More reviews
js_loader
4.8
Como base em 109 críticas
powered by Google
js_loader