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Corneal Collagen Crosslinking

Keratoconus is a degenerative disorder of the eye in which structural changes within the cornea cause it to thin and change to a more conical shape than the more normal gradual curve. Keratoconus can cause substantial distortion of vision, with multiple images, streaking and sensitivity to light all often reported by the person.

It is estimated that eventually 21% of the keratoconus patients require surgical intervention to restore corneal anatomy and eyesight.

C3R (Corneal Collagen Crosslinking with Riboflavin) has been proven to strengthen the weak corneal structure by increasing collagen crosslinking, which are the natural “anchors” within the cornea. These anchors are responsible for preventing the cornea from bulging out and becoming steep and irregular, consequence of advanced Keratoconus.

The C3R treatment is performed in just 20 to 30 minutes. During the treatment, custom-made riboflavin eye drops are applied to the cornea, which is then activated by ultraviolet light. The cornea which is the front transparent structure of the eye is first anaesthetized using drops. The mucous surface of the cornea (epithelium) is disrupted and then Riboflavin, (Vitamin B2) drops are placed in the eye every few minutes. The yellow pigment of the Riboflavin absorbs the Ultraviolet A light, increases the amount of collagen cross-linking in the cornea and strengthen the cornea.. Once the procedure is completed, a soft bandage contact lens will be placed in the eye and antibiotics will be instilled. The contact lens will be removed in one or two days.

The cornea increases in rigidity soon after the procedure although the process of cross linking continues on for a period of a few days afterwards. The effect on corneal shape takes longer but flattening does not occur in all eyes that have had treatment. A satisfactory result will be arresting the progress of keratoconus.

C3R causes the collagen fibrils to thicken, stiffen, and crosslink & reattach to each other, making the cornea stronger and more stable & halting the progression of the disease

Ultraviolet A light used in this procedure is not harmful to the eye in measured doses. Ultraviolet C light (in sunlight) is potentially harmful. The Light emitting diodes used in the C3R device is of a wavelength that is not harmful. Furthermore, light emission is carefully measured and calibrated prior to each treatment. There is also a self diagnostic check on the device which prevents use in case of a malfunction. There have been concerns about toxicity to the retina (at the back of the eye) however the Riboflavin pigment in the cornea and front of the eye absorbs the Ultraviolet light and in effect stops the light from being transmitted to the retina.

Advantages Of Cross Linking

  • Permanent
  • Simple
  • No follow up sittings required
  • No need for admission
  • Stops the progress and causes regression of disease
  • Does not need eye donation as in corneal transplant
  • No major precautions
  • No injections or stitches
  • No incisions as in Intacs or Corneal ring segments
  • Quick recovery with short follow up




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