Corneal Collagen Cross-linking and Intacs® in the Treatment of Keratoconus

By Andrew E Holzman, MD FACS on December 06, 2011

As medical director of TLC Tysons Corner, I routinely attend seminars and read industry journals to remain educated on emerging procedures and technology in the eye care field. The development of the corneal collagen cross-linking procedure represents a huge advance in the industry that will allow thousands more people to see clearly. I am proud that my Virginia LASIK practice has been selected as an official U.S. Clinical Trial study site so that I can offer this treatment to qualifying candidates as part of the ACOS/Topcon Cross-Linking Study. For best results, we typically combine the corneal cross-linking procedure with the use of Intacs® corneal implants.

Corneal Collagen Cross-linking

Corneal collagen cross-linking is currently approved for use in Europe, and the FDA has backed ongoing clinical studies here in the United States. The treatment has shown encouraging results in stopping, and even reversing, the progression of keratoconus and post-LASIK ectasia. Keratoconus is a condition in which the cornea becomes weakened and changes from a round to cone-shape; post-LASIK ectasia refers to a thinning, steepening cornea after laser eye surgery.

The corneal collagen cross-linking procedure involves the application of riboflavin eye drops and ultraviolet light to stabilize and strengthen the cornea:

1.     First, the epithelial layer of the cornea is removed so the riboflavin can penetrate the cornea

2.     Next, riboflavin eye drops are applied, soaking the cornea and anterior chamber for about 20 minutes.

3.     Additional riboflavin drops are applied and the eyes are exposed to ultraviolet light for about 30 minutes. The riboflavin protects the eyes from the UV rays, while also working with the UV light to enhance the collagen structure in the cornea.

4.     Once the treatment is complete, special contact lenses are placed on the eyes to help them heal; the lenses should be worn for about three days.

5.     For about four weeks, patients must apply antibiotic and anti-inflammatory eye drops.

European and U.S. studies have shown promising results in patients; the treatment safely and effectively increases the collagen cross-linking of the cornea, and it prevents the cornea from bulging and becoming too steep or irregular.


The corneal collagen cross-linking procedure can be combined with the insertion of Intacs® corneal implants. These corneal implants are approved by the FDA and are used to treat keratoconus, corneal optical irregularities, and low degrees of nearsightedness. Intacs® are crescent-shaped implants that are made of a material that is similar to a contact lens; they are inserted along the outer edges of the cornea. Intacs® are designed to flatten the cornea, reshape and reinforce the cornea, improve vision, prevent the need for corneal transplant surgery, and get patients to tolerate contact lenses.

If you are interested in joining our corneal collagen cross-linking clinical trial or would like to learn more about corneal collagen cross-linking and Intacs® in the treatment of keratoconus, contact TLC Tysons Corner today. We can determine if you are a suitable patient for these treatments and add you to our list of potential candidates. 

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