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Cross-Link Treatment
It was first used in Dentistry to increase tissue biomechanical stability in 1970s. It was stabilized through cross-linking of UVA photopolymerisation with compounds polymer side chains.

Areas of Application in Medicine

ENT surgeries, heart surgeries, Keratoconous treatments, orthopedic surgeries

First research began with Prof.Dr. Seiler in 1994 in Dresden. It was tried on various animals before it was tried on humans.

MECHANISM OF ACTION

Its main purpose is to increase stability on the cornea's texture.
It does this by strengthening collagen through increasing resistance against additional molecular bands between collagens and enzymatic dissolving.

After the crosslink treatment,
-Evaluation of corneal transparency and
-Evaluation of side effects involving the cornea, retina, and lens

Constitute main elements of the operating principles to apply crosslink treatment on the human cornea.

Riboflavin and UV lights release oxygen radicals and this creates new connections between collagen fibrillaries.


FIELDS OF APPLICATION

• PrimerCornealEctasias
    • Keratoconus – especially advanced keratoconus
    • PellucidMarginal Degeneration

• Post-surgery Ectasia
    • Ectasia developed after laser surgeries
    • Ectasia developed after Lasik –epilasik-PRK

• Corneal Ulcers

WHO IS SUITABLE & WHO IS NOT SUITABLE?

Although it is performed after the age of 18, I have performed it on three 15 year-olds and one 17year-old. These patients had their eye-glasses changed often since childhood due to keratoconus. Upon a 6 month follow-up after the surgery, we noted increasing quality of vision and decreasing corneal curvatures.

Thickness of the cornea is an important factor in patient selection and it should not be less than 400 MICRONS.

We allow for a maximum 60D of corneal curvature value.
There should not be any corneal diseases.
There should not be an active eye infection.
The patient should not be pregnant / breastfeeding at the time.
There should not be Collagen Vascular diseases or autoimmune diseases.

SURGERY PREPARATION

• If the patient is using contact lenses, he/she is asked not to wear them 15 days prior to the day of the surgery,
• A detailed eye examination is performed and refraction is evaluated using a refractometre with and without medication,
• Vision is evaluated with / without glasses,
• Vision is evaluated with contact lenses,
• Cornealbio is evaluated,
• Fundus–retina is examined,
• Corneal Topographical measurements and evaluations are done with Orbscan-Pentacam, • Pacimetrical evaluations – measurements of corneal thickness are done at every point of the cornea,
• ORA, flexibility of the cornea (thickness-strength) is evaluated. Although it is a very new method in keratoconous evaluation, it is being used more and more every day.

SURGERY

All surgeries are performed in the operating room under hygienic conditions. It is important to eliminate the risk of infections.

1st Stage; all of Cornea epithelium is peeled on an area totaling 8-9 mms
2nd Stage; Riboflavin solution is dropped onto the cornea every 2-3 minutes for a total of 30 minutes.
3rd Stage; After making sure that the Riboflavin drops have seeped into the cornea, UV application begins. UV APPLICATION LASTS FOR ABOUT 30
MINUTES and during this RIBOFLAVIN IS APPLIED AT EVERY 2-3 MINUTES during this period.

THE UV LIGHT that I use is Peschkemed, Switzerland ( UV light model developed by IROC Clinic ).

POST SURGERY

An antibiotic eye drop is applied after the surgery, soft contact lenses are placed, and the procedure is finalized. Corneal epithalisation is completed in about 5 days. After this is completed, soft contact lenses are taken out.

The patient continues to use antibiotic and anti-inflammatory drops for 15 days following the surgery.

In follow-ups that are performed every 3 or 4 days, biomicroscobic controls are crucial. Lines in the stroma show effectiveness in collagen fibers.

I prefer following the patient for about 6 months through topographical measurements.

COMPLICATIONS

• Infection
• Corneal endothelium damage (There is no risk of such complication as long as the procedure is not performed on corneas thinner than 400 microns)

FREQUENTLY ASKED QUESTIONS ABOUT CORNEAL CROSS-LINKING

• Can it be performed on both eyes at the same time? No, it cannot be done. We prefer to wait at least a month between the surgeries due to infection risks.
• Is a better vision possible after the CCL surgery? This procedure was not designed to improve vision but to stop keratoconus. However, patients who I applied this procedure on experienced 20% vision improvement after the 3rd month, some up to 30%. However, cloudy vision experienced during the first few days after the surgery should not scare patients. It goes away in time.
• Can Contact Lenses be used after CCL?
If there is a refraction problem and it is corrected with lenses, there is no harm in using them.
• Can rings be placed after CCL?
If there is faulty refraction and contact lenses are not an option, rings can be used.