Collagen Cross-Linking (CCL) using Riboflavin and UV (365nm) exposure  
Also known as
C3R or CXL
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.
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Collagen Crosslinking treatment

Eligibility Criteria

- Patients with progressive Keratoconus
- Minimum corneal thickness of 400

- Maximal keratometry readings < 60 D
- No other corneal disease
- Patients over the age of 16 years

What is collagen cross-linking?
Collagen cross-linking is a new treatment for keratoconus, that uses a photosensitizing agent, riboflavin (vitamin B2) &
ultraviolet light (UVA, 365nm) exposure. In extensive experimental studies (including biomechanical stress & strain
measurements) researchers have demonstrated a significant increase in corneal rigidity / stiffness after collagen cross-
linking using this riboflavin/UVA treatment. The 3 & 5 year results of Dresden clinical study in human eyes 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)

How is the treatment done?
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. After the treatment, antibiotic ointment is applied and an eye-pad is worn overnight until the next day when the
surface of the eye has healed. Oral analgesics are required for the first 1 -2 days

Who can benefit from this treatment?
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.
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Dr Rajesh Fogla, senior corneal surgeon has special interest in keratoconus disorder and its management. He has a vast experience in contact lens fitting, & specialized corneal
procedures to effectively manage this condition.
He has been performing Deep Anterior Lamellar Keratoplasty since 1998, & has numerous publications & presentations on the same

For more information regarding the cost of surgery and other details you can email Dr Rajesh Fogla at or call him on +91 9866076750
Cornea Clinic - Eye Department - Apollo Hospitals, Jubilee Hills, Hyderabad 500096, Telangana,  INDIA
Cornea Clinic - toll free number 1600 345 1066, other numbers 91 40 23607777 ext 6333
Tel 91 40 23607777,  Fax 91 40 23608050 ,24 hours emergency services call 1066
Click here to take a look at
clinical outcome of collagen
crosslinking treatment
Cornea Clinic
Center for Innovative Corneal Surgery
Collagen Crosslinking treatment

Peschke CCL Vario UV device
used for the procedure at Cornea
Options for treatment include the
standard 30 mins protocol using 3mW
exposure, or 10 minutes protocol using
the 9mW exposure.
Accelerated crosslinking can also be
performed in 5 minutes using 18mW

Special riboflavin solutions are used
for thinner cornea to swell them to
appropriate thickness prior to the UVA

Safety has always been our priority
ever since we started performing this
procedure since 2005