​​​​Corneal Cross Linking in Thin Cornea

Corneal Cross Linking is a new method to treat Keratoconus or bulging eye disorder. CXL in children is now an option.

We know that in keratoconus the corneal collagen fibers are decreased in number and volume. This decreases the tensile strength of the cornea to hold back the internal pressure of the eye. We can increase the young’s modulus or the rigidity of the cornea with corneal cross linking. This intervention is more challenging in extremely thin corneas. We need to protect the inner cornea and the inside of the eye from the UV radiation we apply. It has been determined that 400 microns is a safe limit. If the cornea is thinner than that we need to strategize. Also in epi off Corneal Cross Linking we remove the top 5o microns when we discard the epithelium. Hence the cornea has to be more than 450 microns to start safely. Wait there is one more factor we need to be aware of. When we apply epi on or transepithelial procedure It is common knowledge amongst keratoconus surgeons that epi off cxl is more effective than transepi corneal cross linking also know as epi on corneal cross linking. In thin conreas it may used as the 50 micron of epithelium adds a barrier to the UV light.

  • Contact lens assisted C3R What about extremely thin corneas where even the epithelium  protection is not enough a novel strategy has been devised. A 300 micron contact lens is soaked in riboflavin and than placed over the bare cornea. It helps swell up the cornea as well as prevents UVA radiation from penetrating deeper.
  • Photrexa Corneal Cross Linking

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