Corneal Collagen Cross-Linking in Manila: Treatment for Keratoconus

Key Learning Points

1. Corneal collagen cross-linking (CXL) is a non-invasive treatment primarily used to halt the progression of keratoconus, a condition where the cornea thins and bulges outward.
2. This procedure works by strengthening the cornea's structure through the use of ultraviolet (UV) light and riboflavin (vitamin B2), which stiffen the corneal tissue.
3. Keratoconus symptoms include blurred vision, increased light sensitivity, and frequent changes in eyeglass prescriptions.
4. CXL treatment is a relatively quick procedure, taking about an hour, to stop further progression rather than reverse existing damage.
5. Post-CXL care involves regular follow-up visits, avoiding eye rubbing, and protecting the eyes from infection.
6. CXL is effective in halting the progression of keratoconus in up to 90% of cases, especially if detected early.
7. Patients can expect some discomfort in the days following the procedure, but most return to their usual activities within a week.

Introduction

Corneal Collagen Cross-Linking (CXL) has revolutionized the treatment of corneal conditions like keratoconus, a disorder where the cornea becomes weak and progressively thinner, leading to vision problems. CXL is designed to stop the progression of keratoconus, stabilizing the cornea by strengthening its fibers. It is a procedure that can help patients, especially in the early stages, preserve their vision and avoid more invasive treatments, such as corneal transplantation.

Understanding Corneal Collagen Cross-Linking

What is Corneal Collagen Cross-Linking (CXL)?

CXL is a minimally invasive procedure that uses UV light and riboflavin (vitamin B2) to stiffen the corneal fibers, halting the progression of keratoconus and other ectatic corneal diseases. By reinforcing the cornea’s structure, the procedure helps maintain the eye’s natural shape and prevents further distortion that could lead to severe vision loss.

The process works by inducing new cross-links within the collagen fibers of the cornea, much like adding extra reinforcements to a bridge to make it more stable. This treatment is ideal for patients diagnosed in the early stages of keratoconus or other corneal thinning disorders.

Symptoms of Keratoconus

Keratoconus is a progressive condition that primarily affects young adults and teenagers. Symptoms include:

• Blurry or distorted vision: As the cornea changes shape, vision becomes more distorted.
• Increased sensitivity to light: Patients may find bright lights uncomfortable.
• Frequent changes in prescription glasses or contact lenses: The cornea’s shape may change over time, requiring frequent adjustments in eyewear.
• Double vision: Some patients report seeing multiple images of an object.

How Corneal Collagen Cross-Linking Helps

CXL stabilizes the cornea by using a combination of riboflavin drops and UV light. The riboflavin absorbs into the corneal tissue, and when exposed to UV light, it causes new collagen bonds to form, strengthening the structure.

This treatment doesn't reverse the condition but halts its progression. It is especially effective when administered early, as it helps preserve the cornea's shape and function before severe damage occurs.

The Corneal Cross-Linking Procedure

The procedure typically involves the following steps:

1. Preparation: The patient lies down, and the eye is numbed with drops.
2. Epithelial Removal: In some cases, the top layer of the cornea (epithelium) is removed to allow better penetration of the riboflavin.
3. Riboflavin Application: Riboflavin drops are applied to the cornea, saturating it over about 30 minutes.
4. UV Light Exposure: The cornea is exposed to controlled UV light for 10-30 minutes, during which time the riboflavin activates and strengthens the corneal fibers.
5. Post-Procedure Care: The eye is bandaged with a soft contact lens, and patients are given antibiotic and anti-inflammatory drops.

Post-Cross-Linking Care and Recovery

After the procedure, the cornea will need time to heal. Here are the recommended steps for a smooth recovery:

1. Use prescribed eye drops: Antibiotics and anti-inflammatory eye drops will help prevent infection and reduce inflammation.
2. Avoid rubbing your eyes: This can disrupt the healing process and introduce bacteria.
3. Wear sunglasses: Protect your eyes from bright light, as sensitivity may increase for a few days post-procedure.
4. Follow up with your ophthalmologist: Regular follow-ups will help monitor healing and ensure the cornea stabilizes as expected.

Patients may experience mild discomfort, a gritty sensation in the eyes, or sensitivity to light for a few days. Vision may be blurry initially but should improve within the first few weeks. Most patients can resume normal activities within a week, though full visual stabilization may take up to six months.

Preventing the Progression of Keratoconus

Early detection and treatment are crucial in managing keratoconus. Here are some tips to prevent its progression:

• Avoid eye rubbing: Rubbing the eyes can worsen keratoconus by weakening the corneal structure.
• Regular eye check-ups: Early detection through routine exams can identify changes in the cornea before they worsen.
• Follow treatment recommendations: If diagnosed, treatments like CXL can halt the condition’s progression.

Commonly Asked Questions about Corneal Collagen Cross-Linking

1. Is Corneal Collagen Cross-Linking painful?

   • The procedure itself is painless, as numbing drops are used. However, mild discomfort or a gritty sensation may occur for a few days after the treatment.

2. How long does the procedure take?

   • The entire procedure takes about one hour, including the time for riboflavin to absorb into the cornea.

3. How long does it take to see the results?

   • Patients may notice improvements in vision within a few weeks, though full stabilization can take up to six months.

4. Will I still need glasses after cross-linking?

   • CXL halts the progression of keratoconus, but it doesn’t correct vision. Glasses or contact lenses may still be needed.

5. Is corneal cross-linking a permanent fix?

   • CXL stabilizes the cornea, but it doesn’t reverse existing damage. However, it can prevent further progression.

6. Can CXL be repeated?

   • In some cases, repeat treatments may be necessary if the cornea becomes unstable again, though this is rare.

7. Am I a candidate for CXL?

   • If you have progressive keratoconus, CXL may be a good option, especially if the condition is detected early.

8. Is CXL safe?

   • Yes, CXL is a safe and effective procedure that has been widely used worldwide.

9. Can CXL improve my vision?

   • While CXL can stop the progression of keratoconus, it may not significantly improve vision without additional corrective measures like glasses or contact lenses.

10. How soon can I resume normal activities after the procedure?

    • Most patients can return to their usual activities, including work, within a week. However, strenuous activities should be avoided for a few weeks.