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IMPORTANT NOTICE: Patients who experience problems from corneal collagen cross-linking should file a MedWatch report online with the FDA. A normal cornea has crosslinks between its collagen fibers that keep it strong and able to maintain its natural shape. Corneal collagen cross-linking involves saturating the cornea with an opthalmic riboflavin (vitamin B2) solution followed by UVA irradiation. CCL appears to be more effective in the treatment of keratoconus than in the treatment of post-LASIK ectasia.
The long-term durability of the stabilizing effect of corneal collagen cross-linking in the treatment of post-LASIK ectasia is not well-established. Patient age over 35 years was identified as a significant risk factor for complications in one study. Another publication reported that an Italian study found keratoconus patients under age 26 treated with CXL showed the most benefit. Avedro Briefing Package for the Dermatologic and Ophthalmic Drugs Advisory Committee 24 Feb 2015.
FDA Briefing Document, Joint Advisory Committee Meeting, Avedro Corneal Collagen Crosslinking system. Alternatively, you may call FDA at 1-800-FDA-1088 to report by telephone, download the paper form and either fax it to 1-800-FDA-0178 or mail it using the postage-paid addressed form, or download the MedWatcher Mobile App for reporting crosslinking problems to the FDA using a smart phone or tablet.


Corneal collagen cross-linking (CCL, CXL) is a proposed treatment for progressive keratoconus or corneal ectasia (also known as keratectasia) following refractive surgery, primarily LASIK. The cornea naturally creates new collagen crosslinks in response to damage from smoking, diabetes mellitus, and aging.
Corneal ectasia is a progressive protrusion, bulging, or steepening of the front surface of the cornea resulting from biomechanical failure of the cornea. In the epithelium-off (standard protocol) CXL procedure, topical anesthesia is administered to numb the cornea. The epithelium-on technique is associated with less pain and faster postoperative recovery, but is reported by proponents of the standard protocol to be less effective. Learn more about clinical trials for treating corneal ectasia with corneal collagen cross-linking at ClinicalTrials.gov.
Rigid gas permeable contact lenses are the safest option and should be tried before crosslinking. The information contained on this web site is presented for the purpose of warning people about LASIK complications prior to surgery. A meeting of FDA advisors was held on February 24, 2015 to review results of clinical trials and make recommmendations to the FDA.
The photo on the left shows suturing of the reopened RK incisions two weeks after the procedure.


Persons experiencing vision problems or other eye problems should seek the advice of a physician. Although the panel of advisors narrowly recommended approval, the FDA will make a final decision at a later date.
If contact lenses fail, surgical options include intracorneal ring segments (ICRS) or INTACS, and corneal transplant. For this reason, it appears that much of the treatment benefit is lost on the flap in post-LASIK eyes, as the LASIK flap is permanently decoupled from the underlying cornea and therefore provides no biomechanical strength to the cornea.
The photo on the right shows significant fibrotic scarring along the sutured incisions at 6 months.
Next, the cornea is irradiated with a UVA light source for a pre-determined period of time. Postoperatively, antibiotics and corticosteriod drops are administered and a bandaid contact lens is applied.



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