Khanna Vision Institute

Corneal Collagen CrossLinking Riboflavin to Treat KEratoconus 

Breaking News:  FDA has finally approved cross linking of the cornea for Keratoconus Eye Disease - Please Note: Only Epi off Avedro KXL/Photrexa system cross linking is FDA approved.

Halt progression of Keratoconus ASAP

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How Does Corneal Collagen Crosslinking Riboflavin Decrease progression of Keratoconus EYe Disease?

As you will hear in the YouTube video below, corneal collagen crosslinking riboflavin is the latest weapon in the fight against keratoconus. There are other treatment options for keratoconus. Here we are going to impart education on crosslinking of the Cornea.

It stiffens the cornea increasing the Young’s modulus of the cornea. In Keratoconus eye disease the cornea is weak. It is not able to resist the outward pressure from inside the eye. The cornea begins to protrude forward. It is therefore also called bulging cornea. Crosslinking of the cornea is like gluing the fibers together. It unites the strands of the cornea into a single block.

If you want to know more about the biochemical reaction which make this possible, read on. The Riboflavin or Vitamin B complex has special properties. When exposed to UV or Ultraviolet light it generates free radicals. Normally free radicals are bad for health. Here they serve a useful purpose. The liberated free radicals form bonds between the collagen fibers. This converts multiple single rope like fibers into a stronger meshwork.

Types of Corneal cross linking or CXL

There are two main variations of corneal cross linking riboflavin currently. Either epithelium is removed (Epi off) or epithelium is left on (Epi on). The reason for removing the epithelium is to allow uniform penetration by riboflavin. The riboflavin soaks the cornea. It also acts as a barrier to deeper penetration of the UV rays. We know UV rays can damage the inner part of the cornea and the lens. So it is very important that it not be allowed to go deeper than 400 microns. 

corneal collagen crosslinking riboflavin

corneal collagen crosslinking riboflavin

Epi Off is the procedure which is considered superior for keratoconus treatment at the present time. Research has shown it gives uniform and better corneal stiffening. Please look at the colored picture above. It shows a uniform demarcation line between the crosslinked and the deeper cornea when epithelium is removed and uniform riboflavin soaking is done and exposed to UV-A radiation. You may also note that this demarcation line is lacking if epithelium is left on.  In fact as of 2016 no study has shown any technique to be superior to Epioff Cross Linkage of Cornea with Riboflavin.

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Steps in performing Crosslinking of Cornea with Robflavin and UV 

1. Identity of patient confirmed and brought into the surgery room. The eye to be operated on confirmed. Anxiolytic pills may be given. The topography and the pachymetry maps are confirmed.

2. The epithelium ​is removed with a chemical or laser.

3. Riboflavin drops are instilled every few minutes for 20 minutes. The penetration of the riboflavin through the cornea into the eye is confirmed on a slit lamp.

4. UV-A radiation is applied for 10 minutes in accelerated Peschke unit. Bandage contact lens is applied.

Corneal Collagen Crosslinking with Riboflavin is a good option at any age from thirteen to forty five. Above 45 years cross linking has not been shown to be beneficial in primary keratoconus cases. It may still be used in this age group if person is suffering from post lasik ectasia. CXL can be of help before and after corneal transplant.


This is not a painful surgery. A relatively simple procedure in the hands of experienced Keratoconus surgeons. The treatment is usually done one eye at a time. One important caveat is that most of the candidates are children or young adults. A caring and passionate doctor helps make the procedure comfortable. This procedure varies from 20 to 30 minutes, so the keratoconus team has to win the confidence of the teenager or young adult. We have performed Corneal Cross Linking of the cornea in teenagers as young as 13.

Side effects of CXL 

Epithelium on was introduced to overcome side effects of epi off techniques. These side effects include delayed epithelium healing, corneal infections, edema, sterile ulcers and rarely scarring. Epi on technique may lead to non uniform riboflavin penetration.

Please note, currently Corneal Collagen Crosslinking with Riboflavin is not FDA approved but performed under FDA study protocols. . Epi off is the best mode of treatment for keratoconus.

Corneal cross linking has also found use in treatment of corneal infections like acanthaomba cyst infections, usually acquired from swimming pools.

Some investigators are doing research to do asymmetric or focal treatment with cxl. This customized treatment holds great hope for vision correction in bulging corneas.

Why Choose Cross Linking Virtuoso Rajesh Khanna, MD​?

Dr. Khanna has performed cross linking on many patients. He takes a personal interest in your well being. Cross linking procedure can take from 30 to 60 minutes. He is there making sure the treatment is delivered perfectly. The friendly staff keep you engaged so that time flies.

CALL NOW : (310) 482 1240

To learn more and see if Cornea cross linking is a good option for you - Please sign up below.

What You’ll Get When You Sign Up Today:

  1. An App for Keratoconus Treatment
  2. Cure for Keratoconus - ebook
  3. Newsletter on Keratoconus

Affording Cornea Cross Linking for Keratoconus in 2017...

Its all good that FDA has approved cross linking for progressive keratoconus eye disease. The most important question is can you afford the procedure with an expert. Lets us help you overcome this obstacle. Do you have the determination to replace your Starbucks​ coffee with an alleviation therapy for your ailment. For about five bucks a day for three years is all that it takes. No interest. No money down. We will even fight with your insurance to pay towards your treatment. Send your insurance card now to

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