Corneal collagen crosslinking with riboflavin (C3-R) is the only non-surgical treatment that is proven to prevent the progression of keratoconus, and it may even be able to reverse the condition to some extent. Developed in Europe in the late 1990s, C3-R has now proven itself in international clinical studies and is approved throughout the European Union for the treatment of keratoconus. Corneal collagen crosslinking with riboflavin (C3-R) for keratoconus patients as a treatment is both effective and non-surgical.

What is keratoconus?

Keratoconus affects about 1 in 7000 people Keratoconus is a disorder of the cornea characterized by progressive thinning and ectasia which results in deterioration of the quality of vision and also the quality of life. As the disease begins in young adults, it affects the most productive years of life. So far there has been no effective way to stop the progression of keratoconus. Current methods such as rigid contact lens, & intracorneal ring segments only the refractive error can be corrected without any effect on the progression of keratoconus. It is estimated that eventually 21% of the keratoconus patients require surgical intervention to restore corneal anatomy and eyesight. A new modality of treatment, based on collagen crosslinking with the help of Ultraviolet A (UVA, 365nm) and the photosensitizer riboflavin phosphate has been described which changes the intrinsic biomechanical properties of the cornea, increasing its strength by almost 300%. This increase in corneal strength has shown to arrest the progression of keratoconus in numerous studies all over the world.

What is collagen crosslinking ?

Collagen cross-linking is a new treatment for keratoconus, that uses a photosensitizing agent, riboflavin (vitamin B2) & ultraviolet light (UVA, 365nm) exposure. Corneal collagen crosslinking with riboflavin causes the formation of normal chemical links between the collagen protein strands in the cornea. This makes the cornea more rigid and can stop the keratoconus from progressing. The treatment may even cause the keratoconus to reverse to some extent. C3-R may prevent the need for contact lenses if performed early on. Even where contact lenses are already needed, C3-R can eliminate the need for corneal transplantation. No other treatment for keratoconus can offer this; C3-R is unique. Current evidence is that the effects of treatment are permanent. The 3 & 5 year results of Dresden clinical study in human eye has shown arrest of progression of keratoconus in all treated eyes. (Wollensak G. Crosslinking treatment of progressive keratoconus: New Hope. Current Opinion in Ophthalmology 2006; 17: 356 – 360)

Who is suitable for C3-R?

Collagen cross-linking treatment is not a cure for keratoconus, Rather, it aims to halt the progression of the condition. This is important to understand. Patients will continue to wear spectacles or contact lenses (although a change in the prescription may be required) following the cross-linking treatment. The main aim of this treatment is to arrest progression of keratoconus, and thereby prevent further deterioration in vision and the need for corneal transplantation. However in advanced keratoconus, wherein the corneal thickness is below 350 microns, this treatment may not be possible. In such a situation other alternatives such as deep anterior lamellar keratoplasty (DALK) should be considered. Anyone with progressive keratoconus is potentially suitable. Patients with very advanced keratoconus or whose vision is already spoiled by scarring will usually not be good candidates for the procedure. The earlier the treatment is done, the better, but C3-R can still be beneficial decades after keratoconus has begun to develop. To find out how you might benefit from corneal collagen crosslinking with riboflavin (C3-R), contact our Hospital today.

How is C3-R keratoconus treatment performed?

C3-R treatment is a painless, out-patient procedure. The treatment is performed under topical anesthesia. The skin (epithelium) of the surface of the cornea is partially scratched, followed by application of Riboflavin eye drops for 30 minutes. The eye is then exposed to UVA light for 30 minutes. The combination of the light and riboflavin causes chemical bonds to form within the cornea, increasing its rigidity and stability. The whole process takes about one-and-a-half hours. After the procedure, a protective soft contact lens is worn for about 24 hours, and eye drops need to be instilled four times daily for five days and then twice daily for the next five weeks.
Oral analgesics are required for the first 1 -2 days The procedure is extremely safe, and no sight-damaging complications have been reported.

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