Classification corneal cross linking procedure

The Need

When a person needs to choose a doctor providing the latest keratoconus treatment, it is important to understand what treatment is being offered. Sometimes the cheapest may not be best. It can be confusing with lot of medical jargon. Also each keratoconus doc may claim his unique version is the best.

When researchers and Keratoconus surgeons present data and want to compare results, a scientific classification helps.Further innovation can occur along each arm of the classification system.

          Cornea Collagen Cross linking  or CXL

Cross linking with Riboflavin C3R         Cross linking with Rose Bengal C3RB


  • Epithelium OFF
  • Epithelium on
  • Cornea Channel

This is the classic method described By Wollensack et al. Traditionally the epithelium is removed by a chemical like tetracaine or ethyl alcohol. Laser epithelium removal (PTK) is a new variant.

This innovative method was first described by Dr.Boxer-Wachler. The epithelium is irritated to break tight junctions to allow riboflavin(chromophore) to pass.

This is a combination method. At the time of making corneal channel for intacs, riboflavin can be instilled in the channels. Thus riboflavin loading can occur more effectively and rapidly while preserving the epithelium. Since the UVA wavelength is able to pass through the intact epithelium, it may work.


  • 30 min
  •  10min
  • Other


  • 30 min
  • 10 min
  • 6 min


  • Iontophoresis
  • Pulsed

Insert tableClassification corneal cross linking procedure

The above classification is based on and similar to the one proposed by Dr. Hafezi, Randelmann et al.

Learn about corneal collagen cross linking special cost and insurance coverage. We offer FDA approved Avedro epi off classic Dresden protocol conventional cornea cross linking.

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