Crosslinking (CXL): The Gold Standard in Halting Keratoconus
Warsaw · Krakow · Vienna · Zurich
If you have been diagnosed with keratoconus, the most important and urgent step is to halt its progression. At Swisslaser, we employ the gold standard in treating this condition—the Crosslinking (CXL) procedure. We perform it at our clinics in Poland (Warsaw, Krakow), ensuring the highest level of safety, based on unique international experience and groundbreaking technology.
Why Is Our Approach to Crosslinking Unique?
At Swisslaser, we do not “just” perform Crosslinking. We offer comprehensive stabilization therapy at the highest global standard.
What Is Crosslinking? Strengthening the Eye’s Foundation
Imagine the cornea as a scaffold built from collagen fibers. In keratoconus, the connections between these fibers weaken, and the entire structure loses stability. Crosslinking is a process that rebuilds and strengthens these connections. The procedure is simple and ingenious: we saturate the cornea with vitamin B2, then activate it with UVA light, creating hundreds of new, strong cross-links. In over 95% of cases, disease progression is effectively and permanently halted.
Experience That Cannot Be Replicated
Dr. Victor Derhartunian has been performing Crosslinking procedures since 2007, from the very beginning of this method’s existence in Europe. Moreover, he learned it in Zurich directly from its inventor, Prof. Theo Seiler. This ensures that you are under the care of a surgeon with absolutely unique knowledge and experience.
Combining CXL with Laser: Precision “Tailored to You”
We often combine Crosslinking with therapeutic laser treatment (Trans-PRK/PTK). Thanks to our groundbreaking Total Corneal Wavefront technology (MS-39 2nd generation), we create a three-dimensional model of your entire cornea. It is like the difference between a flat map and a precise, satellite-based 3D model. This allows us to precisely “smooth” its irregular surface with accuracy that was previously unattainable.
Treatment of Thin Corneas: For Us, It Is Standard, Not an Exception.
Many patients are told that their cornea is “too thin” for the procedure. At Swisslaser, thanks to years of experience, safe treatment of thin corneas using the sub400 protocol is a standard procedure. Complex cases are our daily routine.
Comparison of the advanced Methods
| Feature | Epi-off Crosslinking (Gold Standard) | Epi-on Crosslinking (Alternative) |
| Procedure | We gently remove the top layer of corneal cells (epithelium) to allow vitamin B2 to penetrate deeper. | The epithelium remains intact or is specially loosened. |
| Advantage | Maximum efficacy and the highest proven rate of halting the disease. | Less discomfort and faster recovery in the first days after the procedure. |
| Indications | Used in the vast majority of cases to provide the patient with the best and most lasting possible outcome. | Reserved for special cases. |
Am I a Candidate?
SwissLaser Traffic Light System
Green Light
(Ideal Candidates)
- Patients with documented keratoconus progression.
- Age typically below 40 years (when the disease is most active).
- Corneal thickness allowing for safe performance of the procedure (thanks to the sub400 protocol, we also treat thinner corneas).
Yellow Light
(Consultation Required):
- Patients with very rapid or very slow disease progression.
- Coexisting conditions, e.g., severe dry eye syndrome.
- Very thin cornea requiring a special protocol.
Red Light
(Not Qualified – but alternatives exist):
- Patients with advanced, central corneal scars.
- Active infections or inflammatory conditions of the eye.
- Pregnancy and breastfeeding (the procedure should be postponed).
Procedure Course and Recovery: What to Expect Step by Step
We understand that the prospect of the procedure may cause concern, so we present its exact course.
Preparation
Upon arrival at the clinic, you will receive anesthetic drops that will completely eliminate pain during the procedure.
Procedure
While lying comfortably, your cornea will first be saturated with vitamin B2 drops. This will be followed by several minutes of UVA light exposure. The entire process for one eye takes approximately one hour.
After the procedure
A special bandage contact lens is placed on the eye to support healing. You will receive a set of medications and detailed instructions.
First Days
The first 2-3 days after the Epi-off procedure are crucial for healing and may be uncomfortable. It is essential to follow the recommendations.
Return to Activity
Return to office work is usually possible after 5-7 days. Full physical activity can be resumed after approximately one month.
Stop the Disease, Regain Control. Schedule a Consultation.
Do not let keratoconus determine your future. The first and most important step is to halt its progression. At Swisslaser, we will do so based on the highest standards of safety and experience.
Frequently Asked Questions (FAQ)
The Crosslinking procedure – step by step
- Qualification: MS-39 tomography with an epithelial map confirms progression of the keratoconus.
- Day of the procedure (approx. 1 hour per eye): after anaesthetic drops, the cornea is saturated with riboflavin and irradiated with a controlled dose of UVA in the C-EYE system.
- Protection: a bandage lens while the epithelium heals.
- Check-ups: 2 visits during the first month included in the package; progression monitoring over the following months.
Recovery day by day
- Days 1–3: the most difficult period – healing of the epithelium can be painful; we relieve the pain effectively.
- Days 5–7: return to office work.
- First months: the cornea gradually stiffens; the result is that the disease is halted, not that visual acuity improves – an important expectation to keep in mind.
Expert commentary
“I have been performing cross-linking since 2007 – I learnt it from Prof. Theo Seiler, the inventor of the method. The most important decision is the timing of the procedure: we operate on progression, not on the mere existence of the keratoconus. That is why, for stable patients, the best decision is sometimes a check-up in 6 months.”
Dr Victor Derhartunian, FEBO, FWCRS – CXL procedures since 2007, trained under Prof. Theo Seiler
Is the Crosslinking procedure painful?
The procedure itself is painless thanks to anaesthetic drops. However, the first 2-3 days afterwards can be uncomfortable. Patients experience pain, burning and light sensitivity, which we relieve effectively with prescribed medication.
What is the price of the Crosslinking procedure in Poland?
The price of the procedure at SwissLaser reflects the highest standard of care, the surgeon’s experience and the use of the latest technologies. During the consultation you will receive a transparent, detailed cost estimate. We also offer convenient instalment plans.
Is the Crosslinking procedure reimbursed by NFZ?
Yes, the CXL procedure is included in the benefits basket of NFZ (Poland’s national health fund). However, you should expect a long waiting time. At SwissLaser we perform the procedure without queues, often combined with additional procedures (such as laser treatment with Total Corneal Wavefront) that are not available under NFZ.
How long does recovery after the CXL procedure take?
The first phase of healing takes around 5-7 days. A return to office work is possible after about a week. Full stabilisation of vision can take several months.
Will I see better after the procedure?
The main aim of CXL is to halt the disease. However, in some patients – especially when we combine the procedure with laser treatment planned using Total Corneal Wavefront technology – there is a significant improvement in quality of vision and a reduction in irregular astigmatism.
Isn’t my cornea "too thin" for the procedure?
This is one of the most common concerns. At SwissLaser, thanks to many years of experience and the use of the special sub400 protocol, we are able to safely treat many patients who have been turned away at other centres.
What does combining Crosslinking with laser treatment involve?
It is a “2-in-1” therapy. The laser (Trans-PRK/PTK), planned on the basis of a three-dimensional map of the entire cornea, precisely smooths its irregular surface. Crosslinking then immediately locks in this new, better shape and halts the disease.
How long does the effect of the Crosslinking procedure last?
According to long-term studies, the corneal strengthening effect is permanent. The procedure is performed once, to halt the disease for life.
When can I go back to driving?
Only once your vision has stabilised and your visual acuity meets the legal requirements. This is usually possible a few weeks after the procedure, which we confirm at a follow-up visit.
Can the procedure be performed on both eyes at the same time?
For safety reasons and for your comfort, we perform the procedures separately for each eye, usually one to several weeks apart.
What are the risks associated with the procedure?
Crosslinking is one of the safest procedures in ophthalmology. The risk of complications, such as infection or transient corneal haze, is very low, especially in the hands of a surgeon as experienced as Dr Derhartunian.
What is the difference between Epi-off and Epi-on? Which method is better?
Epi-off, in which the epithelium is removed, is regarded worldwide as the gold standard because of its highest, proven effectiveness. Epi-on is a less invasive but potentially less effective method, which is why we reserve it only for very specific cases.
Will I still have to wear rigid lenses after the procedure?
The aim of the combined treatment (CXL + laser) is to improve the shape of the cornea to the point where comfortable glasses or soft contact lenses can be worn instead of cumbersome and often poorly tolerated rigid lenses.
I am over 40. Does the procedure still make sense?
Yes, if our precise diagnostics show that the disease is still progressing. Although progression after the age of 40 is less common, it does still occur, and in such cases Crosslinking is very much indicated.
Why should I choose Crosslinking at SwissLaser rather than elsewhere?
Because at SwissLaser you receive more than just a procedure – you receive comprehensive care built on three pillars: the surgeon’s globally unique experience, access to breakthrough technologies (Total Corneal Wavefront, the sub400 protocol) and an international standard of safety.
