Cross-linking Treatment By Valeri Nikolov in Bulgaria

Here I share only my experience and, in some cases, my personal opinion. I will not talk about the crosslinking, what it is and what is does to the eyes. Here I share my experience during and after the operation. For those who are interested in more formal documents about crosslinking, please find them in the site.  Luckily, there are now plenty of articles describing the nature and the techniques of the procedure. That all is thanks to our friends from the Gustav Carus clinic in Germany. I visited them in the end of March 2005.

They warmly welcomed me in their facilities. The procedure took half a day as they made exhaustive examination before taking decision to do or not to do.  They made cornea topography scan, cornea thickness scan, vision scan and interocular pressure scan. I met Dr. Kohlhaas, who won my respect as very energetic and dedicated professional. He explained me all the things regarding the operation. Many of them I already knew, but it was good to hear them from himself.

The operation cost was 500 euro per eye.

The procedure went as follows:

Anesthetic drops were applied to both eyes.

They put me in horizontal position. Using some needle like tool they did some scratches otherwise said, they opened the epithelium. After that they put the UV light emitters above my eyes and started the light which I saw as green. Each five minutes they put the famous riboflavin drops. The drops felt really good; otherwise the light was burning my eyes. At the middle of the procedure, they put me once again anesthetic drops. I remember the man who was doing the operation talking to me, which was very kind of him, because this way the operation went faster and put me away from the discomfort and the burning.

That was it, from a patient’s point of view it is that simple.  From that point, however, comes the long process of recovery which I think is as important as the operation itself.

I divide the post-crosslinking period in several stages.

1. Right after the procedure.

2. First day after the procedure.

3. Closing of epithelium.

4. Restoration of natural tear flow.

5. Back to normal.

It's a little discomforting, but necessary to say, that the first 24 hours after the operation are a little tough of a time. I know that there are much harder operations and surely more painful. However, if one decides to do crosslinking I believe he or she must put the discomfort second place and not pay much attention to it. But let me describe the feelings because I think it is better one to have an idea what is going to happen.

First thing to notice after the operation is that vision is very weak. If one chooses to do one eye only, then this is not a problem, but if he or she decides to do both eyes, then this is a little of an issue. The question I myself asked before the procedure was exactly what vision I would have just after the operation. Would I be able to see faces, would I be able to find my way out of the clinic? The answer is: Sure one can see the faces and the walls and the door, so that he or she can find the way out.

I actually found my way to the main entrance of the university clinic quite easily. About fifteen minutes after the operation the anesthetic drops' effect is gone. So it is a good idea for one to go to the guest house or the hotel at that time. It is far more pleasurable to stay in bed with curtains on, instead of walking around.

Big issue is photo sensitivity. Get yourself very good sunglasses and bear in mind that even the glasses cannot stop the light. I remember staying in the car with glasses and my jacket over my head and the light was passing through them and was causing significant discomfort.

The tears are also worth mentioning. After the operation one has much tear-flow. It continues at least two days after the procedure. Drinking water and wet tissue compresses for the forehead will help. Get strong food as well. Hopefully your appetite will not suffer. At least mine did not.

I experienced foreign body sensation in my eyes but that was not painful, just alarming. I didn't know if that was normal or if it would fade away... actually it faded away after a day or two.

I recommend anyone who decides to do the operation to reserve 3 days in the guest house for post-operational recovery; one before the operation, and two nights for after the operation. If it is possible, get an accompanying person with you so that there is one to give you a hand.

After first couple of days, the epithelium closes. After that my vision started to restore. I am limited to my own experience and cannot tell what the average recovery time is. I, myself, saw the world a little foggy. After a week that feeling faded away as well, although the vision was still weak.

I also experienced eye dryness. I started using re-wetting drops. If you choose to do so, get one with new generation of preservatives like Alcon Systane and Novaritis Genteal. The single dose with no preservatives at all is the best choice. I think that Alcon products are better. At least the best I know.

The first month I used therapeutics lenses. Therapeutics lenses are soft lenses with very low water content and high gas permeability. The kind I got was for continuous use. I used them for a week (day and night) before soaking them for a night. I asked dr. Kohlhaas if that is ok and he confirmed that it was ok. I felt very well with them and I recommend everyone trying them (please consult eye professional first), as they protect the cornea from dust, from the lid (while blinking). Each blinking is pain when your cornea is damaged. I think they helped the cornea and allowed faster growing of the epithelium cells. The lens helped me see a bit better.

At the second month after the operation, the eye dryness was starting to go away. I used rewetting drops more rarely but anyway I found that they feel good as they clean the eye from dust and other impurities. Anyway it is a good idea to put a drop or two on each eye each morning and evening.

Also I tried soft lens correction, unfortunately with no luck. The soft lens may help a little but not as much as the hard ones. The gain is probably one line. I also tried soft toric, but It turned out that the toric lens would not act as expected as it will not rotate to fit in place. You may know that the toric lens are expected to rotate by themselves to position in a certain manner so that they can correct astigmatism. In my case, however, due to the irregularity of the cornea the toric lens would not rotate at all, but stayed blocked in a random position. That is why I gave up trying to correct with regular soft lens. I have not tried special soft lens for keratoconus.

I tried again the RGP. The optometrist worked hard and found some fit that I could tolerate. The vision correction was perfect; however, I did not feel my corneas was strong enough yet. That was on the 10th week after the operation. We recorded the lens parameters so that when a week or two more pass I will go again to the optometrist, make new fit and compare. If it turns out that my corneas are stabilized I will try using RGP.

I visited the optometrist on the 15th week after the procedure to see if my vision was stable enough. It turned out that the metrics we had recorded three weeks ago were of no value to me as the cornea continued to change. According to the metrics it turned out that I needed flatter lens. So, judging by the lens and the fluorescent model, it seems that the cornea continues to flatten even on the fourth month after the procedure.

At the fifth month after the procedure I visited my doctor again and found the following. Left eye was recovered so that it did not need correction at all. Right eye was corrected successfully with glasses. That is something I couldn't dream of before the operation.

I got my glasses, left eye was 0.5 cyl. 70 deg, right 2.0 cyl.  60 deg. NO diopters at all! I consider this the greatest success, as after two years with contact lenses I really enjoyed only having to wear my glasses very much. A week after I got the glasses and my vision got adapted i got even better and sharper view.

Topography taken one month after Cross Linking

Topography taken six months after Cross Linking

Today is 13th of December 2006. Almost two years since I visited Dresden and more than a year since, I wear the same glasses. My vision is still the same, stable enough, no change since the day I got my glasses after getting treated with crosslinking.