CCL

1. your solution in corneal cross-linking
Cross-Linking Procedure UV-X 2000
Indications
- Progressive keratoconus
- Iatrogenic ectasia (e.g. after LASIK)
- Pellucid marginal degeneration
- Recurrent keratoconus after corneal graft
- Peripheral melting diseases
Contraindications
- Corneal thickness <400 µm in swollen state (without epithelium)
- Epithelial healing disorders (e.g. MDF)
- Nuclear rheumatic disorders
- Herpes keratitis (UV can activate herpes)
- Pregnancy
Necessary Equipment
- UV-X 2000 illumination system
- Innocross-R 0.1%/dextran 20% solution 2ml
- Innocross-R hypotonic riboflavin 0.1 % solution 2ml
- BSS, sterile physiological balanced salt solution
- Protection ring
- Operating table and instrument table
- Slit lamp with blue light
- Pachymeter
- Bladed speculum
- Hockey knife
- Topical anaesthetics (i.e. oxybuprocaine, tetracaine)
- LASIK sponges
- Merocel™ sponges or similar
- Gauze (for fluid collection)
- Adhesive tape
- Bandage contact lens
- Postoperative medication (like after PRK: antibiotics, steroids)
Prior to Treatment
- Mandatory: remove rigid contact lenses two weeks prior to surgery
- Discontinue vitamin C treatment one week prior to surgery
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2. your solution in corneal cross-linking
Treatment
Prior to first treatment on any working day check radiation output with power meter.
1. Drop topical anaesthetics (e.g. oxybuprocaine, tetracaine).
2. Clean eye with Eye-CleanTM or similar solution.
3. Insert lid speculum.
4. Pachymetry with epithelium, central or thinnest point
5. Partially remove the corneal epithelium (8 – 9 mm diameter). (Riboflavin molecule
is too large to penetrate intact epithelium, thus epithelial removal is essential for
effective diffusion of riboflavin).
6. Begin dropping riboflavin/dextran solution: 1 drop every 2 minutes for 30 minutes
(= 15 drops).
7. After 30 minutes check at slit lamp with blue light whether anterior chamber is
slightly yellow. If yes, go to next step. If not, continue to drop riboflavin/dextran
solution until anterior chamber is yellow.
8. Check corneal thickness again. If under 400 µm without epithelium, use
hypotonic riboflavin 0.1% solution to swell cornea. 2 drops every 10 – 15
seconds until corneal thickness is at least 400 µm.
9. Cover and protect the limbal stem cells by use of a protection ring. Only clear
cornea should be irradiated!
10. UV-illumination treatment: position patient under UV-X illumination device (lying
position is preferred). Turn on UV-X and focus according to the UV-X2000 user
manual (distance between beam aperture and eye ~ 45 mm). Center the beam
to the cornea’s thinnest point.
11. Administer BSS every two minutes to keep the cornea moist and one drop of
Riboflavin solution after 5 minutes illumination time.
Remember: Riboflavin solution has 2 functions:
- initiating cross linking effect when radiated with UV
- protecting endothelium, lens and macula by absorbing UV-light
12. After 10 minutes of UV-illumination switch off UV-X device.
13. Apply antibiotic ointment on the cornea and then cover cornea with a bandage
contact lens
14. Give post-op medication similar to post-PRK: pain killers, steroids, antibiotics.
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