Keratoconus surgery: Corneal collagen cross-linking recovery time

Keratoconus surgery: CXL (Corneal collagen cross-linking) also known as C3R is the only surgical method that halts the progression of Keratoconus. C3R with riboflavin (Vitamin B2) and UVA is the safest procedure and popular worldwide. This procedure was first reported on 1997 at the university of Dresden by Spoerl et al(1). Initially, application of CXL was for the treat the corneal ulcer not for Keratoconus. It used to halt the corneal melting for corneal ulcer patients (2).

Studies reported that after the keratoconus surgery (CXL), it takes approximately 3 months for vision stabilization (3). The patient can feel the loss of vision or blurred vision after the surgery. A major cause of temporary vision loss is due to stromal edema. Also, many cases have seen corneal haze which gradually reduces by the period of time. The majority of cases mild stromal haze appearing at 2-6 weeks after surgery and disappearing by 9-12 months. Complications are reported on case studies like infectious keratitis, stromal haze, sterile infiltrates, endothelial failure and corneal melt. The causes of infectious keratitis are due to microbial agents and corneal melt occurs at epithelial healing phase. Cases of bacterial infection with Staphylococcal epidermidis, Escherichia coliPseudomonas aerunginosa and Coagulase-negative Staphylococcus, as well as Acanthamoeba, have all been reported (5-7).


Sterile infiltrates seen at early postoperative phases which usually resolves after few weeks of keratoconus surgery with corticosteroid medication.

Endothelial failure also reported but very rare evidence.

The success rate of CXL is approximately 98% (8). Initial condition getting worse for 1-2 months then flattering cornea up to 12-24 months. Also, few studies reported that uncorrected visual acuity improves 1-2 Snellen lines after 1-4 years period of surgery. It also improves best corrected visual acuity in few cases.

So Rgp wearer can start wearing lenses after 3 months of surgery but it may be differing depends on conditions. The parameter of the Rgp contact lenses may be changed or may not be.

Also read

  1. Spoerl E, Huble M, Kasper M, Sieler T. Increased rigidity of cornea caused by intrastromal cross-linking.Ophthalmologe.1997;94:902–6. [PubMed]
  2. Scnitzler E., Sporl E., Seiler T. Crosslinking of the corneal collagen by UV radiation with riboflavin for the mode of treatment melting ulcer of the cornea, first results of four patients.Klin Monbl Augenheilkd.2000;217:190–193. [PubMed]
  3. Mazotta C, Balestrazi A, Baiocchi S, Traversi C, Caporossi A. Stromal haze after combined riboflavin-UVA corneal collagen cross-linking in keratoconus:In vivoconfocal microscopic evaluation. Clin Experiment Ophthalmol. 2007;35:580–2. [PubMed]
  4. Caporossi A, Mazzotta C, Baiocchi S, Caporossi T. Long-term results of riboflavin ultraviolet A corneal collagen cross-linking for keratoconus in Italy: The Seina eye cross study. Am J Ophthalmol. 2010;149:585–93. [PubMed]
  5. Raiskupf-Wolf R, Hoyer A, Spoerl E, Pillunat L. Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: Long term results.J Cataract Refract Surg.2008;34:796–801. [PubMed]
  6. Rama P., Di Matteo F., Matuska S. Acanthamoeba keratitis with perforation after corneal crosslinking and bandage contact lens use.J Cataract Refract Surg.2009;35:788–791. [PubMed]
  7. Pollhammer M., Cursiefen C. Bacterial keratitis early after corneal crosslinking with riboflavin and ultraviolet A. J Cataract Refract Surg. 2009;35:588–589. [PubMed]
  8. Perez Santonja J., Artola A., Javaloy J. Microbial keratitis after corneal collagen crosslinking. J Cataract Refract Surg. 2009;35:1138–1140. [PubMed]
  9. Raiskup-Wolf F., Hoyer A., Spoerl E., Pillunat L.E. Collagen cross-linking with riboflavin and ultraviolet A light in keratoconus: long term results.J Cataract Refract Surg. 2008;34:796–801. [PubMed]

Krishnendu Mandal

Optometrist, Blogger, Blogging since Jan 2016