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Corneal collagen cross-linking

(CXL)

ALIREZA PEYMAN, MD

ISFAHAN UNIVERSITY OF MEDICAL SCIENCES

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CXL with riboflavin and ultraviolet-A irradiation introduced in 1998

Spoerl E, Huhle M, Seiler T. Induction of cross-links in corneal tissue. Exp Eye Res. 1998;66:97–103.

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IndicationsCornea ectasias

KCPMD

Iatrogenic ectasiasPost-LASIK keratectasia

Infectious ulcersCorneal edema

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Importance of age of the patient

<10 years old 10-20 years 20-30 30-40 >40

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Technique

Using a wavelength of 370 nm with an accumulated irradiance of 5.4 J/cm2 ensures that the exposure of all structures is below harmful levels

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Epi-Off

Epi-On

Penetration of riboflavin

Role of oxygen

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Irradiation

Conventional

Accelerated

Pulsed

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Complications

Significant haze

CTK

Infection

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Combinations

CXL + ICRSCXL + Microwave keratoplasty

(Keraflex)

CXL + PRKCXL + LASIK

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Is repeat CXL helpful?

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