Collagen Cross-Linking (CXL)
Patients with inherited corneal weakening disorders like keratoconus, keratoglobus, or pellucid marginal degeneration (PMD), including those with surgically weakened corneas caused by complications of deep Lasik and Radial Keratotomy (RK) surgeries, can experience abnormal protrusions (steepening/bulging/ectasia) and in often cases, an exaggerated curvature which results in adverse changes in vision and refractive error (glasses or contact lens prescription).
Collagen Cross-linking (corneal cross-linking, CXL, CCL, C3) is a technology that allows firming of the corneal tissue. Dr. Gulani gives an analogy to describe this technique very similar to turning cellophane paper to plastic consistency, so you can imagine it becoming stronger (crosslinked). Cross-linking involves using specially formulated Riboflavin (Vitamin B12) drops along with a special pulsed UV (ultraviolet) light technology that bonds the collagen of the cornea to strengthen and make it more firm so it is more resistant to bending.
With over three decades of experience with nearly all technologies and protocols of collagen cross-linking worldwide given his international privileges, Dr. Gulani uses his proprietary techniques not only in patients with all kinds of keratoconus including Keratoglobus and Pellucid Marginal Degeneration (PMD), but has successful employed this technology (PeschkeTM, Switzerland) in patients with surgical complications like those following Lasik, Radial Keratotomy (RK), HEX-K, and INTACS.
He offers Cross Linking as an important ingredient in the spectrum of keratoconus treatments in single as well as in his unique combination surgical approaches (KLEAR ™) to help keratoconus and Corneal Ectasia patients at all levels of severity from mild to advanced.
Dr. Gulani teaches eye surgeons to apply cross-linking when measurement is impossible due to vision fluctuations to “Prepare” for vision corrective surgery or in those cases where following vision corrective surgery (Repair) on a compromised cornea, he wishes to “trap” that successfully acquired vision correction for long term stability.
Gulani Kerato-Scoliosis Concept
Cross-linking is an important modality in the full spectrum approach of Dr.Gulani’s “Think Outside The CONE” protocol for Keratoconus but we have seen an increase in complications being referred to us from all over the world due to indiscriminate cross-linking by eye surgeons under a pretense of preventing worsening of the keratoconus.
This is analogous to putting cement on a bent back (scoliosis) with a promise of preventing further bends in that spine, but why wouldn’t a surgeon straighten that spine (keratoconus) first?
Dr. Gulani’s Kerato-scoliosis spine/cornea concept is clearly visualized in this image which illustrates that even though pouring cement (Cross-linking) on the spine prevents the spine from bending further, the spine should first be straightened (vision improved) before the application of the cement or else that patient is locked in with their disability for life.
Though Dr. Gulani has successfully still corrected vision for many such indiscriminately cross-linked patients, he teaches prevention of such irresponsible occurrences in the best interest of the patients.
Cross-Linking Complication Correction
With Dr. Gulani’s experience and track record with collagen cross-linking technology and additionally his ability to use it in combination with different vision enhancing and restorative techniques, he is a world destination for fixing complication of collagen cross-linking surgery itself. Patients and eye surgeons from around the world refer their patients with collagen cross-linking complications from irregular corneas to uncontrolled keratoconus and blinding scars which he has successfully corrected with his proprietary systems straight to vision. Below are some prototype cases of cross-linking complications that Dr. Gulani has corrected from all over the world:
This patient traveled from Egypt to Dr. Gulani in Florida after multiple failed keratoconus surgeries including Keraring, PRK, PTK, and cross-linking with his eye surgeons in London, US, Canada, Egypt, and Dubai. Dr. Gulani designed his no-cut, no-flap surgery and brought him straight to vision.
This patient has undergone multiple collagen cross-linking treatments for his keratoconus with his eye surgeon in Miami and was left with poor vision. He could not tolerate contact lenses and was very impacted by this disability. His eye doctor knew of Dr. Gulani’s reputation for fixing complications of other keratoconus surgeon’s complications and insisted that he seek him. This patient underwent Dr. Gulani’s unique T-INTAC surgery to vision and is fascinated by his outcomes and new lease on life.
This patient underwent multiple failed cross-linking (CXL, C3R, CCL) procedures in Canada, California, and Miami along with ICL surgery and was left with poor vision. Having traveled to so called “keratoconus experts” he was finally referred to Dr. Gulani who designed his No-Cut, No-Blade LaZrplastique and now sees 20/20 without any glasses or contact lenses.
This patient underwent multiple failed surgeries all over the world (Mexico, California, Texas, etc.). Surgeries like Radial Keratotomy (RK), cross linking (CXL, C3R, CCL), PTK, including corneal transplant that left him with corneal ectasia and blindness. His eye surgeon recommended that he travel to Dr. Gulani where he underwent Laser Corneoplastique and was corrected within minutes.
This patient traveled from California with cross linking and INTACS complications that left him with a blinding scar and extreme irregular astigmatism. He underwent Dr. Gulani’s custom designed Laser Corneoplastique with Scar Peel.
This patient was referred to Dr. Gulani with Cross-linking Complications of Keratoconus with keratometry of 86.90 D, Extremely thin 200 µm Cornea with Central full thickness Blinding scar brought to immediate Correction with 17 D improvement.
