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What is Corneal Crosslinking? Strengthening the cornea in a targeted manner

Was versteht man unter Crosslinking

Imagine the collagen fibers of your cornea as the supporting beams of a scaffold. With keratoconus, these beams lose their connections to each other, and the scaffold becomes unstable. The crosslinking procedure restores these connections.

The process is as simple as it is ingenious:

  1. Saturation with riboflavin: Your cornea is prepared with high-dose vitamin B2 drops (riboflavin).
  2. Activation by UVA light: The cornea is then irradiated with precisely dosed UVA light.
  3. Formation of new connections: The UVA light activates the riboflavin, which triggers a biochemical reaction. This reaction creates hundreds of new, stable crosslinks between the collagen fibers.

The result: Your cornea becomes significantly firmer, stiffer, and more resilient again.

More than just a procedure: A strategic treatment

Femto-LASIK 7D

At our clinic, crosslinking is not an isolated procedure but part of an individual, strategic treatment plan. While CXL takes over the biochemical stabilization, it can be useful in some cases to first mechanically stabilize and shape the cornea.

In advanced cases, we may therefore first implant biological ring segments (CAIRS). These immediately strengthen the cornea and improve its shape. Only in a second, later step do we then perform cross-linking—often combined with a surface-smoothing laser treatment—to secure the final result.

What is corneal crosslinking?

The ultimate goal: Avoiding a corneal transplant

EDOF

A corneal transplant (keratoplasty) is a major surgical procedure with a long healing period and the risk of rejection.

Our modern treatment philosophy has changed this paradigm. Through the early and targeted use of crosslinking to stop the disease, and the use of advanced procedures such as CAIRS to rehabilitate the corneal shape, a corneal transplant can now be successfully avoided in the vast majority of cases. Preserving and strengthening your own tissue is always the best and safest option.

The treatment process: Your day at EyeLaser Zurich

We have designed the entire process to be as comfortable and stress-free as possible for you.

Arrival & Preparation

You will be received in our clinic. Your eye will be prepared with numbing drops so that you feel nothing during the entire procedure.

The intervention

You lie comfortably on a couch. Depending on the procedure, the epithelium is removed, and the riboflavin drops are applied over a period of approx. 20-30 minutes.

The irradiation

You then look into the UVA light for a few minutes. Your position is continuously monitored.

Conclusion

After the irradiation, a protective bandage contact lens is placed on your eye. This remains there for a few days to support healing.

The crosslinking procedures in detail: Safe and individual

We select the most suitable procedure for you after a careful examination.

Feature Epi-off Crosslinking (The gold standard) Epi-on Crosslinking (The gentler alternative)
Procedure The top cell layer of the cornea (epithelium) is gently removed. The epithelium is chemically loosened or remains intact.
Advantage Maximum effectiveness and highest success rate, as the riboflavin can penetrate optimally. Significantly less discomfort in the first few days, faster regeneration.
Recommended for The vast majority of patients to achieve the best possible, lasting result. Selected cases, e.g. for very pain-sensitive patients.

Special case thin cornea: The Sub400 protocol
A corneal thickness of 400 micrometers has long been considered the lower limit. For patients who fall below this value, we offer the special Sub400 protocol an. We use special riboflavin drops that swell the cornea to a safe thickness before UVA irradiation. This allows us to treat eyes with thinner corneas safely and effectively as well.

Our expertise: Why the surgeon’s experience is crucial

Dr. Victor Derhartunian

With crosslinking, precision and experience are key to success.

Dr. Derhartunian about his experience:
“I had the privilege of accompanying crosslinking from the very beginning. When I started it at the University Hospital Frankfurt in 2007, it was a brand new, hopeful method. Later, at the IROC Clinic in Zurich, I was able to learn directly from Professor Theo Seiler – the inventor of the procedure. I now pass on this profound experience and understanding of the nuances of the treatment to each and every one of my patients.”

This unique combination of many years of practice and training with the pioneers of the method offers you an invaluable degree of safety at EyeLaser.

Advantages of crosslinking for corneal bulging

Treat degenerative diseases & prevent damage

Crosslinking can stop the protrusion or stiffening (PMD), slow down its progression or cause it to regress. The result: a stable cornea.

Low-risk & effective treatment option

With a success rate of over 95%, crosslinking is extremely effective and can be performed again if stability decreases. The complication rate is less than 3 % .

Correction of visual defects through follow-up treatment

Caused and pre-existing visual defects can be corrected by regularizing the cornea. Lens implantation or trans-PRK improves your vision, allowing you to gain quality of life.

Treat degenerative diseases & prevent damage

Crosslinking can stop the protrusion or stiffening (PMD), slow down its progression or cause it to regress. The result: a stable cornea.

Low-risk & effective treatment option

With a success rate of over 95%, crosslinking is extremely effective and can be performed again if stability decreases. The complication rate is less than 3 % .

Correction of visual defects through follow-up treatment

Caused and pre-existing visual defects can be corrected by regularizing the cornea. Lens implantation or trans-PRK improves your vision, allowing you to gain quality of life.

Costs and health insurance clarification: We can help you

Presbipia

The question of costs and processing with the health insurance company should not be an additional burden for you.

  • Crosslinking is a recognized mandatory benefit of basic insurance for a diagnosed, progressive keratoconus.
  • A “cost approval” from your health insurance company is required for reimbursement.
  • Our service for you: Our experienced team actively supports you in obtaining cost approval and professionally compiles all the necessary medical documents and reports for you.

The first step towards a stable future: Get advice

Crosslinking is the most important decision to regain control over keratoconus. If you are looking for a safe and proven method performed by one of the most experienced specialists, you have come to the right place.

Check your suitability for crosslinking in Zurich – make your appointment now!

FAQ: Frequently asked questions about crosslinking in Zurich

What exactly does crosslinking do for my keratoconus?

Crosslinking is a kind of “reinforcement therapy” for your cornea. Through the combination of vitamin B2 drops (riboflavin) and UVA light, hundreds of new, stable connections are created between the collagen fibers of your cornea. This makes the tissue significantly stiffer and more resistant again, which stops further progression of the cone-shaped bulge in over 95% of cases.

Is the result of crosslinking permanent?

Yes. According to the current state of scientific knowledge and long-term studies spanning more than 10 years, the corneal stiffening achieved through crosslinking is permanent. The goal is to stop the disease with a single treatment so that no further stabilising procedures are necessary.

Will I be able to see better with crosslinking?

The primary and most important goal of crosslinking is to stop the progression of keratoconus, not to improve vision. In some patients, a slight flattening of the cornea and thus a slight improvement in vision occurs as a positive side effect. However, you should not rely on this. A targeted improvement in vision is achieved through other, subsequent procedures.

 

Do I have to be treated immediately after diagnosis?

Not necessarily. Treatment is necessary when a clear progression – i.e. a deterioration – of keratoconus is proven. We use our high-precision diagnostics with the MS-39 to objectively measure changes and determine the perfect treatment time for you.

 

Is the crosslinking treatment painful?

The procedure itself is completely painless thanks to numbing eye drops. However, we often hear this concern. Honestly, the first 1-3 days after the procedure (especially with the Epi-off procedure) are uncomfortable. You may experience pain, a foreign body sensation, and severe light sensitivity. However, we will give you effective painkillers and an exact eye drop plan to get you through this phase well.

 

How long will I be unable to work after crosslinking?

Plan for a downtime of about one week. During this time, the top layer of the cornea (the epithelium) heals. For office work, you can usually return to work after 5-7 days. You should avoid physically strenuous or dirty work for at least two weeks.

 

When can I drive again after the procedure?

Your vision will fluctuate in the first few weeks after the procedure. You may not drive again until you feel absolutely safe and the legally required visual acuity has been stably achieved again. This can take several weeks and will be checked during the follow-up examinations.

 

When can I exercise or go swimming again?

Light sporting activities such as jogging or the gym are usually possible again after 1-2 weeks. You should refrain from visiting swimming pools, saunas and steam baths, as well as contact sports, for at least one month to protect against infection.

 

How much does a crosslinking treatment cost in Switzerland?

The costs for such a specialized procedure can vary. At EyeLaser, you will receive a detailed and transparent cost estimate as part of the preliminary examination. However, the question of cost coverage is more important.

 

Will my health insurance (basic insurance) cover the costs of crosslinking?

Yes. For a diagnosed and demonstrably progressive (progressing) keratoconus, corneal crosslinking is a recognized mandatory service of Swiss basic insurance. The prerequisite for this is a cost approval, which must be obtained from your health insurance company before the procedure. Our experienced team actively supports you in this process.

 

My cornea is very thin. Can I still be treated?

Yes, in many cases. The former lower limit of 400 micrometres is no longer considered absolute today. Bei EyeLaser wenden wir für solche Fälle spezielle und sichere Protokolle an, wie das “Sub400 protocol”. The cornea is swollen to a safe thickness with special drops before the treatment is carried out.

 

Can both eyes be treated at the same time?

For safety reasons and to make your regeneration phase as pleasant as possible, we usually treat the eyes at separate appointments. The interval between treatments is usually one to four weeks.

 

What are the risks of crosslinking?

Crosslinking is a very safe and proven procedure. As with any procedure, there are rare risks such as delayed healing, infection, or temporary corneal clouding (“haze”). In the hands of an extremely experienced surgeon like Dr. Derhartunian, who has been using the procedure since 2007, the risk is minimal.

 

Can crosslinking be combined with laser treatment?

Yes, that is one of our great strengths. You can combine the laser (topo-guided Trans-PRK/PTK) directly with crosslinking to stabilize the cornea and smooth its surface at the same time. This can significantly improve the quality of vision.

 

Why should I have crosslinking performed at EyeLaser in Zurich?

Because you benefit from a unique combination: the immense experience of Dr. Derhartunian, who learned the procedure directly from the inventor, state-of-the-art diagnostics for precise planning, and a team that accompanies you not only medically but also personally throughout the entire process.