Crosslinking Plus

What is Corneal Collagen Crosslinking Plus (CXL+)?

Corneal Collagen Crosslinking Plus (CXL+) refers to a modified or combined version of the standard corneal cross-linking (CXL) procedure. It involves combining cross-linking with other vision-correcting treatments to both halt the progression of keratoconous and improve visual outcomes. This approach takes advantage of the corneal stabilisation achieved through cross-linking while incorporating additional procedures to reshape the cornea or correct refractive errors such as nearsightedness or astigmatism.

Common Procedures Combined with Cross-Linking (CXL Plus):

Topography-Guided PRK (Photorefractive Keratectomy):

What it is: PRK is a laser vision correction procedure that reshapes the cornea by removing a small amount of tissue from the surface. In topography-guided PRK, the laser treatment is customised based on the patient’s unique corneal shape and irregularities (mapped using corneal topography).
Why it's combined: By pairing PRK with cross-linking, patients can not only stabilise their cornea but also improve their vision by reducing irregular astigmatism, nearsightedness, or other distortions caused by keratoconous.
How it works: PRK is typically performed first to smooth and reshape the cornea, and then cross-linking is done to stabilise and strengthen the reshaped cornea.
Benefits: This combination improves both corneal strength and visual clarity.

Intra corneal Ring Segments (INTACS or CAIRS):

What it is: INTACS or CAIRS are small, semi-circular implants inserted into the cornea to help flatten its bulging shape and improve visual function in patients with keratoconous.
Why it's combined: The combination of INTACS or CAIRS with cross-linking (CXL Plus) helps both stabilize and reshape the cornea. INTACS correct the irregular corneal shape, while cross-linking strengthens the corneal structure to prevent further thinning or progression of keratoconous.
How it works: Typically, the rings are implanted first, followed by cross-linking to lock in the reshaped corneal structure.
Benefits: The dual approach can improve vision by addressing the corneal bulging and provide long-term stabilization by cross-linking.

Phakic Intraocular Lenses (ICL):

What it is: ICLs are implantable lenses placed inside the eye to correct significant refractive errors like nearsightedness or astigmatism. These lenses are typically used in patients with high prescriptions that cannot be corrected with glasses or contact lenses alone.
Why it's combined: Cross-linking stabilises the cornea, while ICLs correct the refractive errors caused by keratoconous, offering improved visual clarity without needing a corneal transplant.
How it works: After cross-linking has stabilised the cornea, the ICL can be implanted at a later date to correct vision.
Benefits: It provides a safe, effective, and reversible way to improve vision in keratoconous patients.

Customised Contact Lenses (Post-CXL):

What it is: Specially designed contact lenses, such as scleral lenses, can be fitted after cross-linking to correct vision and provide a smooth, clear surface over the irregular cornea.
Why it's combined: While cross-linking stabilises the cornea and prevents further progression, it may not always fully restore normal vision. Combining it with advanced lens technology allows for better vision correction in patients with residual irregular astigmatism.
How it works: After cross-linking, patients are fitted with customised lenses that correct the irregular shape of the cornea.
Benefits: This combination improves both vision stability and visual clarity, reducing the need for more invasive procedures.

Why Choose Corneal Cross-Linking Plus (CXL Plus)?

Vision Improvement: CXL Plus offers not only stabilisation of keratoconous but also an opportunity to improve vision quality. The additional procedures are designed to correct refractive errors or reshape the cornea, resulting in better visual outcomes.

Tailored to Patient Needs: The approach is customised based on the severity of the keratoconous, the level of visual impairment, and the patient’s specific corneal shape. This personalised approach allows for optimised results.

Prevention of Future Deterioration: By combining corneal cross-linking with vision-correcting procedures, CXL Plus helps preserve vision in the long term, preventing further vision loss or the need for corneal transplants.

Who Is a Candidate for CXL Plus?

Progressive keratoconous Patients: Patients whose keratoconous is worsening may benefit from the cross-linking portion to stop progression, while the additional procedure helps address vision correction needs.

Patients with Refractive Errors: Those with significant astigmatism, nearsightedness, or irregular corneal surfaces can benefit from the "Plus" aspect, improving their vision post-cross-linking.

Post-LASIK Ectasia Patients: Patients with corneal ectasia, a complication of LASIK surgery, may also be candidates for CXL Plus, particularly if vision correction is also required.

Benefits of CXL Plus:

Dual Approach: It addresses both the cause of keratoconous progression (weakening of the cornea) and the symptoms (poor vision).

Customisable: Various procedures can be added to cross-linking, depending on the patient's individual needs and corneal condition.

Prevents Future Procedures: By stabilising the cornea and correcting vision simultaneously, CXL Plus can potentially reduce the need for more invasive treatments like corneal transplants in the future.

Faster Visual Improvement: In some cases, combining these procedures can result in more immediate visual improvement than cross-linking alone.

Risks and Considerations:

Post-Procedure Healing: Combining procedures can extend recovery time. For instance, pairing cross-linking with PRK involves healing from both treatments.

Not Suitable for Everyone: Patients with advanced keratoconous or extremely thin corneas may not be eligible for CXL Plus and might require other treatments like corneal transplants.

Complexity: Since CXL Plus involves multiple procedures, it requires a skilled surgeon with experience in performing both cross-linking and the additional treatments.

Conclusion:

Corneal Collagen Crosslinking (CXL) is an advanced, combination approach designed for patients with keratoconous or corneal ectasia, offering a two-in-one solution: stabilising the cornea through cross-linking while improving vision through additional procedures like PRK, INTACS, or customised lenses. This tailored approach can help patients maintain better long-term vision while preventing further deterioration, making it a highly effective option for those with early to mid-stage keratoconous.

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Also I forgot to mention (rima) she was so kind.

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I had LASIK surgery yesterday, and it was the best decision I've ever made. The entire staff at the clinic Os incredibly professional and always ready to answer any questions you may have. The surgery itself O was quick and painless. The surgeon and nurses are very skilled at making you feel relaxed, and they even play music if you're feeling particularly anxious or nervous during the procedure. You may cry a lot after surgery, but after a good nap, your eyes will feel like they've been restored to their former glory. Would definitely recommend!

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Dr. Mani, the surgeon, was incredibly impressive. He took the time to explain every detail of the procedure and answered all my questions with patience and clarity. His expertise and professionalism were evident, and I appreciated how he genuinely cared about my concerns. It's clear that Dr. Mani is not only skilled in his field but also deeply committed to his patients' wellbeing.
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Maida

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Debra Virginia

Very happy and impressed with the highly professional care and service I’ve received at the Optimal Vision clinic. Dr Mani is so professional, and he explained everything about Laser surgery and answered all my questions. The surgery was quick and almost completely painless. My eyes have healed perfectly and quickly. I would highly recommend this clinic.

Samira Emadi

My husband had been experiencing discomfort in his left eye since July and was seen by various doctors/consultants even at the Queen Mary’s hospital but no abnormalities were found.
This week Dr. Mani discovered the fault which happened to be Retina detachment with three tears.
Dr. Mani’s preciseness and his perfectionist attitude to attention to details, detected the source of the main issue and saved my husband’s eye. We feel utterly grateful and can not recommend him enough for his excellence.

Shirin Amani Azari

CXL+