Crosslinking is a technique developed by Dr Theo Seiler in 1998 in Germany. It is a reliable and widely used technique to improve and strengthen the biomechanics of the cornea.
It is carried out by administering drops of riboflavin (vitamin B2) to the ocular surface, followed by application of ultraviolet light. This induces the formation of new connections between adjacent collagen fibres in the cornea, thereby increasing its rigidity through a photopolymerisation process.
Crosslinking is applied for the sole purpose of strengthening the cornea. For this reason, it is most often used in the treatment of keratoconus and pellucid marginal degeneration.
Keratoconus is a hereditary disease in which there is progressive deformation of the cornea caused by lack of rigidity, with thinning and increased corneal curvature.
To perform an early and accurate diagnosis of keratoconus, topography or topometry testing must be done which will detect of subtle changes.
Crosslinking is an ideal pre-surgical treatment to prevent disease progression.
The primary objective of Crosslinking is for the riboflavin to penetrate and spread well over the cornea (stroma). This is done using one of two techniques
- Classic Crosslinking: Remove the corneal epithelium.
- Transepithelial Crosslinking: Without removing the surface epithelial layer
In both cases, ultraviolet light is applied which is absorbed by the riboflavin, releasing free radicals which induce the formation of disulfide bonds between adjacent collagen fibres. This leads the cornea to become stiffer, creating links between the fibres in the corneal stroma, increasing the number of bonds between the collagen molecules.
Both techniques are performed under topical anaesthesia and are completely painless, allowing the patient to leave the operating room without help.
Crosslinking should not be used in any of the following situations:
- Patient under 16 years old
- Corneal thickness below 400 microns
- Patient has had herpetic keratitis
- Presence of opacification due to dense corneal scarring and Vogt striae
- Patients with severe dry eye syndrome.
The surgery is performed by our expert surgeons with early detection of any “biomechanical weakness” being of paramount importance.
Using crosslinking early strengthens the corneal and avoiding continued weakening.
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