Cross-linking plus

What is cross-linking plus?

Cross-linking plus combines 2 treatments:

1. Topography-guided PTK

An excimer laser is first used to remove a very thin layer from the surface of the cornea. The laser is guided by a detailed map of the cornea, known as topography. The aim is to flatten the irregular conical shape of the cornea and make it more regular. When preparing the treatment plan, particular attention is paid to keeping the treatment as minimally invasive as possible. 

2. Corneal cross-linking

The cornea is then strengthened using riboflavin (vitamin B2), and ultraviolet light (UV-A). This treatment creates additional bonds, known as cross-links, between the collagen fibres in the cornea. This makes the cornea stronger and slows the progression of keratoconus. Read more about collagen cross-linking. 

Aim

Cross-linking plus strengthens the cornea and also makes it more regular.

• By strengthening the cornea, we slow further progression of the keratoconus.
• By making the cornea more regular, we aim to improve the quality of your vision.

What does cross-linking plus involve?

Duration

The treatment is performed as an outpatient procedure: you may return home the same day.

• The treatment itself usually takes just over half an hour per eye.
• You should expect to spend 2 to 3 hours at the hospital.

Before the procedure

• You are first given anaesthetic eye drops.
• The eye is then disinfected and covered with a sterile drape.
• A mild sedative is also usually administered.
• The treatment is performed while you lie comfortably beneath the laser.

Treatment

• The surgeon first performs the laser treatment.
• Riboflavin is then applied to the eye in drops.
• Once the cornea is sufficiently saturated, the eye is exposed to UV light.

Aftercare

The first few days after the treatment are usually somewhat uncomfortable.

Common symptoms

• Pain or a burning sensation
• Watery eyes
• Sensitivity to light
• Blurred vision

These symptoms gradually improve during the first week.

After the treatment, use eye drops for several weeks according to the schedule provided to you.

Important precautions

• Do not rub the eye.
• Use the prescribed eye drops correctly.
• Protect the eye from dust, dirt and sunlight.
• You must temporarily refrain from swimming.
• Attend all scheduled follow-up examinations.
• Do not wear eye make-up.

Outcome: recovery of vision

Your vision may fluctuate or be blurred during the first few weeks. The final result develops gradually over several months.

Some patients experience a clear improvement in vision, while for others the main aim remains to stabilise the cornea.

If your vision remains inadequate with glasses, a custom-made contact lens can be fitted so that you can still achieve good vision.

Your ophthalmologist will discuss beforehand whether this treatment is suitable for you and what results can realistically be expected.

Possible risks and complications

As with any eye treatment, complications are rare but possible.

Possible risks of cross-linking plus include:

• Infection
• Inflammation
• Temporary clouding of the cornea
• Dry eyes
• Scarring
• Insufficient improvement in vision

Follow-up examinations

Several follow-up appointments are scheduled after the treatment. During these examinations, we assess the healing of the cornea and monitor the stability of your vision and the keratoconus.