In the past few years a new treatment method of keratoconus is applied in great success, called collagen interface (corneal cross linking). This innovative method, started by the research team of Professor Theo Seiler at the University of Dresden, is already being implemented in Europe, America and Australia. The safety of the method has already been certified by the European Community (CE mark).
The treatment is painless and performed under aseptic conditions with local anaesthesia with anaesthetic drops. At first, the corneal epithelium is removed (the most superficial layer of the cornea, as the epidermis is for the skin). Afterwards, follows a dripping of riboflavin solution (vitamin B2) for 10 minutes. After having established the impregnation of the deeper layers of the cornea with riboflavin, follows the irradiation of the cornea with ultraviolet (UV) UV A radiation of suitable intensity, for 3 minutes.
The irradiator of corneal KXL of the AVEDRO company (UVA cross linking) features digital screen for setting the intensity and the time of irradiation with ultraviolet A radiation.
During irradiation the molecule of the riboflavin
is destabilizes and forms new chemical bonds with the collagen fibrils of the cornea (cross links). The doctor performs the cross linking treatment with the latest technology machine (KXL of AVEDRO), where the corneal irradiation with UVA required, lasts only 3 minutes. This results in the mechanical stabilization of the cornea, which is now stronger and therefore, any further deterioration of keratoconus stops. At the end of the treatment a therapeutic contact lens is worn for 2-3 days until the epithelium of the cornea is fully regenerated.
The indications for treatment are:
Patients aged between 14-40 years old with keratoconus
Patients with ectatic dystrophies of the cornea (pellucid marginal degeneration, iatrogenic keratektasia)
Patients with infectious keratitis unresponsive to medication (germs resistant to antibiotics administered). UVA radiation kills the resistant microorganisms.
All patients undergoing treatment in cross linking, the thinnest point of their cornea is to be larger than 375mm.
Patients with advanced keratoconus are not to undergo this treatment. These patients should do a corneal transplantation (penetrating or anterior lamellar keratoplasty), which has a success rate of 95%.
The results after the cross linking is really good. Studies from various centres abroad but our country's as well, show that treatment manages to stop the progression of keratoconus in nearly 100% of cases. In a significant percentage of patients was also observed regression of keratoconus (flattening of the cone) in the topography and improved visual acuity. The regression does not appear immediately but after a few weeks, while it appears to continue for months after surgery.
The treatment is safe and complications were not observed postoperatively. The right choice of patients (thinnest point> 375mm) and adherence to the surgery protocol is a prerequisite.
In conclusion, we can say that the interface of the collagen of the cornea (corneal cross linking) is a safe and effective method of stabilization (not elimination) of the keratoconus and other ecstatic cornea dystrophies.
Proper patient selection and adequate specialization of the physician healer ensure very good results.