How to Prepare for Corneal Cross-Linking (CXL) Surgery: Tips and Advice

Corneal collagen crosslinking eye closeup

Keratoconus and Post-LASIK ectasia are progressive eye conditions where the cornea, the clear front part of the eye, gradually thins and develops a cone-like bulge. This irregular shape can significantly impair your vision, causing blurriness, astigmatism, and light sensitivity. As keratoconus or Post-LASIK ectasia progresses, the structural integrity of the cornea weakens, putting you at risk of further vision loss and potential corneal scarring.

Corneal cross-linking (CXL) surgery is a specialized procedure that can help strengthen and stabilize the cornea, preventing the progression of keratoconus and, in some cases, even improving your vision. By using specialized light and eye drops, the CXL process reinforces the cornea’s collagen fibers, creating stronger bonds that help maintain the cornea’s shape and prevent further distortion.

What is Corneal Cross-linking (CXL) Surgery?

Corneal cross-linking, or CXL, is a minimally invasive surgical procedure that aims to halt the progression of keratoconus and other corneal ectatic disorders. The procedure involves the application of riboflavin (vitamin B2) eye drops, followed by exposure to ultraviolet (UV) light. This process triggers a chemical reaction that strengthens the cornea’s collagen fibers, creating a “cross-linking” effect that helps stabilize the cornea’s structure.

There are multiple forms of CXL but the classic procedure is epithelium off, aka Epi-Off, CXL. The CXL procedure is performed as an outpatient procedure, taking approximately 60 minutes to complete. During the procedure, your eye will be numbed with anesthetic eye drops, and the epithelium (the outermost layer of the cornea) may be partially removed to allow for better penetration of the riboflavin drops. Once the riboflavin has fully saturated the cornea, your surgeon will expose the cornea to the UV light, which activates the cross-linking process.

Benefits and Potential Risks of Corneal Cross-linking (CXL) Surgery

The primary benefit of corneal cross-linking surgery is the potential to halt the progression of keratoconus, preventing further corneal distortion and vision loss. In some cases, CXL may even lead to a slight improvement in visual acuity by reshaping the cornea. By strengthening the cornea, CXL can also reduce or prevent the need for more invasive treatments, such as corneal transplants, in the future.

However, as with any surgical procedure, there are some potential risks associated with corneal cross-linking, including:

  1. Temporary vision changes: You may experience temporary blurriness, glare, and light sensitivity in the days and weeks following the procedure as your cornea heals.
  2. Infection: There is a small risk of infection, which can be managed with antibiotic eye drops prescribed by your surgeon.
  3. Corneal scarring: In a small percentage of patients, the CXL procedure may lead to the formation of corneal scars, which can impact your vision.

Your eye care professional will thoroughly discuss the potential risks and benefits of CXL surgery with you, helping you make an informed decision about whether it is the right treatment option for your specific condition.

Who is a Suitable Candidate for Corneal Cross-linking (CXL) Surgery?

Corneal cross-linking is typically recommended for individuals with a confirmed diagnosis of keratoconus or other corneal ectatic disorders, such as post-LASIK ectasia. To be considered a suitable candidate for CXL, you should meet the following criteria:

  • Active progression: Your condition is actively progressing, as evidenced by changes in your corneal shape and vision over time.
  • Corneal thickness: Your cornea is thick enough to safely undergo the CXL procedure.
  • No significant scarring: Your cornea does not have significant scarring or opacities that could interfere with the effectiveness of the CXL treatment.
  • Good overall eye health: You should have no other significant eye conditions or diseases that could complicate the CXL procedure or recovery.
  • Realistic expectations: You should understand the potential benefits and risks of CXL and have realistic expectations about the outcome.

Your eye care professional will thoroughly evaluate your eye health and medical history to determine if you are a suitable candidate for corneal cross-linking. 

Preparing for Corneal Cross-linking (CXL) Surgery – Tips and Advice

Preparing for your corneal cross-linking surgery can help ensure a smoother procedure and recovery process. Here are some tips and advice to keep in mind:

  1. Discuss your medical history: Share your complete medical history with your eye care professional, including any underlying health conditions, medications, or previous eye surgeries. This information will help your surgeon tailor the CXL procedure to your individual needs.
  2. Arrange for transportation: Arrange for someone to drive you to and from your CXL surgery, as you will not be able to drive yourself immediately after the procedure due to the numbing eye drops and potential vision changes.
  3. Prepare for recovery: Familiarize yourself with the expected recovery timeline and any activity restrictions that your surgeon may recommend. Having a plan in place for your recovery can help ensure a smoother transition.
  4. Ask questions: Don’t hesitate to ask your eye care professional any questions you may have about the CXL procedure, the risks, the expected outcomes, or the recovery process. Understanding what to expect can help alleviate any concerns and ensure you are fully informed about the treatment.

By taking these preparatory steps, you can help ensure a successful CXL surgery and a more comfortable recovery experience.

The CXL Procedure and Recovery

Corneal cross-linking generally does not require general anesthesia. Instead, your eyes will be numbed with anesthetic drops. Then, your eye surgeon will remove the corneal epithelium and apply riboflavin eye drops. Next, the cornea is exposed to UV light and finally a bandage contact lens will be applied. 

During recovery, you may experience some sensitivity to light or discomfort – this is normal. Your doctor will prescribe  an antibiotic and anti-inflammatory eye drops for a period of time. The bandage contact lens will be removed a few days after the procedure once the corneal epithelium has healed, generally the discomfort and light sensitivity will be resolved at this time. You may experience some vision fluctuations during the first few weeks after the procedure. Attending follow up appointments and following your doctor’s post operative instructions is key to a smooth recovery. 

Conclusion

Corneal cross-linking is a revolutionary treatment that halts  keratoconus and other corneal ectatic disorders from getting worse, reducing the need for more invasive treatments, such as corneal transplantation, in the future. By strengthening the structural integrity of your cornea, CXL can help you  take an active role in preserving your vision.

If you are living with keratoconus or another type of corneal ectasia, we encourage you to schedule a consultation with  the team at CLEI to discuss whether corneal cross-linking surgery may be the right treatment option for you. They lead a central role in the US FDA clinical trials that lead to the approval of CXL in the United States, and continue to actively research various forms of CXL.

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