Информации за тековно работење во услови на Ковид - 19


Cross linking is a method of treating the ocular condition of keratoconus.

Keratoconus is the most common degenerative corneal change that takes on a conical shape.

It affects about one in two thousand people, more often men than women. The disease occurs in all populations around the world, although it is more common in some ethnic groups.


Keratoconus is manifested by thinning and protrusion of the cornea in the form of a cone. As a result of this protrusion, light is incorrectly refracted when it enters the eye, resulting in image distortion that is difficult to correct with standard spherical or cylindrical glasses.

The cause is multifactorial. A genetically predisposed cornea or a completely healthy cornea can get keratoconus if exposed to certain environmental factors that trigger it (triggers). Stimulating factors are severe itching of the eyes (mechanical rubbing of the cornea), frequent allergies, inflammation and irritation from the environment.

New research highlights the importance of hormones in the development of keratoconus. Thus, cortisol (stress hormone) is considered one of the main triggers in modern life. Also, the balance of estrogen and progesterone during pregnancy can cause rapid disease progression.


The initial symptoms are:

  • Difficulty focusing at night;
  • Scattering of light around a light source in the form of haloes or stars;
  • In daylight, on the other hand, photosensitivity or hypersensitivity occurs.
  • Ophthalmologist examinations may show rapid diopter and cylinder growth or change in cylinder axis. Those who wear contact lenses become hypersensitive to the lenses, and later on do not achieve good vision regardless of the type of aid (glasses or lenses).

At a very advanced stage of the disease, when the cornea becomes too thin, small cracks may appear in it, which causes eye pain and sudden blurring of vision.


Candidates for the crosslinking method are the following:

  • Any patient under the age of 25 who is diagnosed with keratoconus.
  • Every patient over 25 years of age, diagnosed with keratoconus, in whom on two consecutive Pentacams in an interval of 1 year we have recorded disease progression.
  • Every patient over 25 years of age with a diagnosed keratoconus, who subjectively shows a rapid decrease in vision or from the medical documentation shows an increase in diopters and a decrease in visual acuity in the last year.

Those patients with advanced stage of keratoconus, who cannot wear lenses and their visual acuity is below 30%, with pronounced corneal thinning, are candidates for corneal surgery. In young people under 30 it is done immediately!

If corneal decompensation occurs and it loses its transparency irreversibly, then corneal transplantation is the only method of choice for these patients.


An ophthalmological examination is performed to check the condition of the vision, which consists of: refraction, determination of visual acuity, measurement of intraocular pressure, i.e. a complete examination of the anterior segment of the eye.

An analysis is then performed with Pentacam – computerized corneal topography. This diagnostic is used to digitally display the relief of the cornea with mathematical models that show if there are any abnormalities.

Monitoring of the development of the condition is done with OCT – Optical Coherence Tomography and again Pentacam analysis.

Course of operation / intervention

If the patient is a candidate for surgical treatment of keratoconus, the cross linking method is used.

  • Cross-linking method (corneal collagen cross-linking or CXL) is an eye surgery performed to stop or slow the progression of the disease.

The method is as follows:

  • The epithelium (outer protective layer of the cornea) is removed;
  • Riboflavin (vitamin B2) is instilled into the cornea until it is completely filled (like a sponge);
  • Ultraviolet radiation irradiates the cornea until riboflavin is activated in it.
  • The method itself lasts from 60 to 90 minutes, is performed according to a precisely defined protocol (Dresden protocol) for the best results.

The method itself is not dangerous for the vision or the eye, it can be performed many times, but usually only one cross linking is needed in life because its effects last about 20 years.

People who are recommended cross linking are patients with keratoconus, whose corneal thickness is not less than 390 microns, patients whose cornea is clear and without scars, whose corneal meridian values ​​have a maximum of 58 diopters, and the visual acuity with glasses is 0.9 or lower.

What most people with keratoconus are interested in is whether and when they can see well. Treatment of keratoconus is slow and requires patience. Finally, once we have achieved a firm and flat cornea with the cross linking method and after determining the stability of the disease, we can proceed with the correction.

The patient is checked out of hospital immediately after the intervention.

Conservative treatment with glasses and lenses is recommended for older people with stable keratoconus or for young people 4-6 months after cross linking. Contact lenses and glasses do not stop the progression of keratoconus, nor strengthen the cornea, but provide better vision by correcting the diopter itself.

Postoperative care

In the first 3 to 5 days the patient may feel pain and discomfort.

After the intervention, patients wear soft contact lenses for several days, until the surface layer of the eye (epithelium) is restored.

As therapy they use topical (eye drops) antibiotic and anti-inflammatory drops for about 6 weeks which are prescribed by the ophthalmologist. The follow ups are performed every two weeks due to the measurement of the intraocular pressure and the examination of the cornea, the healing, as well as the riboflavin in it.

The effects of cross linking regarding the hardening and flattening of the cornea appear gradually, from the day of the intervention, in the next 6-8 months, and even one year after the procedure. On the day of the intervention, only riboflavin (a photoactive substance) is activated, which then creates chemically strong bonds in the very structure of the cornea that can last for months. That is why control Pentacams are made several months after the procedure.


In the first postoperative period, while there is still a therapeutic soft contact lens in the eye, the patient must not wash their face with water and must pay special attention to hygiene.

The patient needs to rest from any obligations for about a week. They will be especially sensitive to daylight, which is why it is especially important to rest and refrain from any additional activities and wear goggles.

ROSE K lenses

ROSE K are special lenses designed for patients who have keratoconus cornea. With them we can achieve excellent visual acuity in people with advanced keratoconus, so that the disease itself is not an obstacle even in performing certain specific professions that require precise observation (driving, factory work or web design).

The vision is always primarily corrected with glasses. Depending on the diopter and the height of the cylinder, we can suggest contact lenses to the patient: soft or RGP (semi-hard gas-permeable).


The package includes: intervention with local anesthesia, home therapy and two follow-ups within 2 months of operation.

There is an opportunity to pay in installments without interest and additional costs.

You can check more about the payment method on the current price list of Sistina Ophthalmology.

 Examination for keratoconus

Examination of anterior segment and pentacam diagnostics.



Detailed corneal analysis.


Fitting ROSE K lenses

Specialised lenses for keratokonus.


Cross linking method

The price is for one eye.