Does CXL stop the progression of keratoconus?

Follow-up studies spanning 10–15 years have shown that disease progression is largely halted. CXL has also been proven to significantly reduce the need for corneal transplantation.

What is the difference between epi-off and epi-on?

In the epi-off (classic) method, the epithelium is scraped off and removed; this allows full penetration of riboflavin but requires 3–5 days of healing. In the epi-on method, the epithelium is preserved and specially formulated drops are used; recovery afterward is more comfortable, although some specialists debate whether the vitamin penetrates deeply enough.

Who is suitable for CXL?

Patients with early/moderate stage keratoconus, who do not yet have serious vision loss, whose corneal thickness is within normal limits, and who show signs of progression are suitable candidates for CXL. Suitability is determined through a detailed examination.

keratoconus

Corneal Collagen Cross-Linking (CXL / Cross-Linking)

CXL is a method used in keratoconus treatment to increase the structural strength of the cornea in order to halt the progression of the disease. It was first applied in Turkey in 2004 by Prof. Dr. Efekan Coşkunseven.

Prof. Dr. Efekan Coşkunseven

Ophthalmology · Istanbul

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Corneal cross-linking (CXL) is a minimally invasive procedure that aims to halt the progression of keratoconus by creating new, permanent bonds between the collagen fibers of the cornea using riboflavin (vitamin B2) and UV-A light.

What Is Corneal Collagen Cross-Linking (CXL)?

CXL is a method used in keratoconus treatment to increase the structural strength of the cornea in order to halt the progression of the disease. It was first applied in Turkey in 2004 by Prof. Dr. Efekan Coşkunseven.

How Does the Treatment Work?

The treatment is based on a combination of riboflavin (vitamin B2) and UV-A light. This interaction creates new, permanent covalent bonds between the collagen fibers of the cornea, significantly increasing its mechanical strength.

Two Protocols

Epi-off (classic): The epithelium is scraped off and removed. This allows full penetration of riboflavin but requires 3–5 days of healing after the procedure.
Epi-on (newer method): The epithelium is preserved, and specially formulated drops are used. The process afterward is more comfortable; however, some specialists debate whether the vitamin penetrates deeply enough.

Suitable Patient Profile

Early/moderate stage keratoconus
Patients who do not yet have serious vision loss
Those whose corneal thickness is within normal limits
Cases showing signs of progression

Scientific Evidence

Follow-up studies spanning 10–15 years have shown that disease progression is largely halted. It has also been proven to significantly reduce the need for corneal transplantation.

Frequently Asked Questions

Does CXL stop the progression of keratoconus?

Follow-up studies spanning 10–15 years have shown that disease progression is largely halted. CXL has also been proven to significantly reduce the need for corneal transplantation.
What is the difference between epi-off and epi-on?

In the epi-off (classic) method, the epithelium is scraped off and removed; this allows full penetration of riboflavin but requires 3–5 days of healing. In the epi-on method, the epithelium is preserved and specially formulated drops are used; recovery afterward is more comfortable, although some specialists debate whether the vitamin penetrates deeply enough.
Who is suitable for CXL?

Patients with early/moderate stage keratoconus, who do not yet have serious vision loss, whose corneal thickness is within normal limits, and who show signs of progression are suitable candidates for CXL. Suitability is determined through a detailed examination.