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Corneal Cross-Linking

DISCLAIMER! The information on this website is general information. Please discuss with your surgical provider your concerns and questions about the procedure. Your personal health information may differ from the information presented here.

Corneal collagen cross-linking is a surgical procedure that strengthens the cornea in order to prevent progressive thinning and worsening of astigmatism that can be caused by keratoconus, pellucid marginal degeneration, or other forms of corneal ectasia (or “warpage.”). This is the first procedure that has been shown in numerous studies to slow or stop the worsening of these disorders. The approval of “epithelium-off” Dresden protocol cross-linking using the Avedro UV light and riboflavin marked an important advance in the care of corneal ectasia in the United States. Cross-linking is helpful for patients who have progressive corneal ectasia changes on corneal topography testing or based on a history of worsening vision associated with an increase in nearsightedness and/or astigmatism. Corneal ectasia tends to progressive more rapidly in younger patients, so children, adolescents, and patients in their 20’s are generally treated more aggressively. Younger patients should be screened for progression more frequently or treated more quickly in order to prevent progression and loss of vision. The procedure is performed on one eye at a time, usually starting with the eye that has more severe corneal changes or more rapid progression. Cross-linking is generally not done if a patient has severe corneal scarring or if the cornea is too thin at which point a corneal transplant (PK or DALK) may be most appropriate.

Cross-linking is done in the office for the majority of patients. The procedure involves removal of the corneal epithelium, soaking the cornea for approximately 30 minutes with riboflavin drops, and activation of the riboflavin with a 30-minute exposure to the Avedro UV source. After the exposure is complete and the cornea has been cross-linked, a bandage contact lens is placed on the eye. There is usually some discomfort for the first several days after the procedure as the corneal surface heals. The bandage contact lens is removed once the surface has fully healed. It generally takes 3 months for the cornea to stabilize although some changes may be noted for up to 1 year after the procedure. Once the cornea is stable, the patient may be tested for a new pair of spectacles or fitted for a new contact lens.