CXLink™ is available at the following centres:

BMI Mount Alvernia Hospital
Manchester Royal Eye Hospital
Sheffield Royal Hallamshire Hospital

Corneal Collagen Cross-Linking

Cross-linking is not a new technique and has long been used as a medical interventional technique in other areas such as dentistry. However, in recent years it has gained momentum in the treatment for stabilising keratoconus. First performed in 1997, it is now being used by a number of prominent Ophthalmic surgeons here in Europe.

It is a non-surgical method utilising a UVA light source, which is delivered onto the Cornea, together with a chemical mix largely made up of riboflavin for strengthening the collagen fibres within the corneal structure. The combination of the UVA light and the riboflavin creates a joining or bonding of the chemical structures within the cornea. The effect is similar to the change we commonly see when toasting bread. A fine slice of bread bends easily and has little strength but after toasting, the bread results in being stronger and slightly more compact.

This comparatively simple procedure has been shown in laboratory and clinical studies to increase the amount of collagen cross-linking in the cornea and subsequently strengthen the cornea. There are published European studies, to show that this Cross Linking procedure has been proven safe and effective in patients with
few side effects reported. Additionally, retreatment is an option at a later date if required.

Cross-linking therapy is being used for a number of diseases of the cornea and is proving a useful treatment in conjunction with other surgical techniques such as Intacs and refractive laser surgery.

However cross linking is not for everybody. The first requirement is to ensure that the thickness of the cornea is adequate for the treatment. Special non-invasive measuring devices are used by your specialist to accurately and quickly take these readings.

Below is a topography maps for a patient of ours who underwent cross linking for keratoconus.

In the scans, map B (the middle column) is the map taken before the cross linking procedure and map A (the left sided column) is the map taken after cross linking. The column on the right shows the difference the cross linking has made to the topography. There is a significant shrinkage of the ‘cone’ after cross linking. This patient experiences an improvement in vision, contact lens comfort, and reduced glare and haloes.

The Cross Linking Procedure

The procedure of Cross Linking itself takes just 30 minutes and may be either conducted in an Operating theatre or a special “clean” room. The eye is anaesthetized with drops and the surface cells are removed. Riboflavin eye drops are applied every two minutes for 20 minutes. At the end of these 20 minutes, application of the ultraviolet light is commenced for a further 10 minutes, with further application of the Riboflavin eye drops.

At the end of the procedure, the Consultant will wash the corneal surface with a special solution and a protective bandage contact lens is placed for a period of 1-2 weeks.

What are the risks of Cross Linking?

Risks of the procedure (to all structures of the eye) are minimal. The main risks are infection, and inflammation of the cornea after surgery but these risks are extremely low. Rigorous observation of the indications and contraindications has been conducted.

After Cross Linking, patients often experience:

• Post-operative pain and sensation of foreign body in the eye for 24-48 hours after treatment until re-epithelialisation is complete
• Watering of the eye for 24-72 hours after treatment
• Transient corneal oedema with visual blurring for 30-60 days after treatment
• Corneal haze usually occurs but clears in the first 8 weeks


Your LaserVision consultant surgeon can expertly guide you through the best treatments for you. Each treatment is personalised to achieve the best results.

In association with:
Sheffield Teaching Hospital NHS Foundation Trust, Greater Manchester University Hospitals NHS Foundation Trust