Corneal Cross Linking (C3R)


Corneal cross-linking, commonly referred to as C3R, is the name of an eye procedure that strengthens the cornea of your eye that has typically been weakened by keratoconus, LASIK surgery or other corneal diseases. Corneal cross linking is also referred to as corneal collagen cross linking.

There are two basic kinds of corneal cross linking: epithelium-off CXL and epithelium-on CXL:

  • In epithelium-off C3R, the epithelium (the thin outer layer of your cornea) is removed.

  • In the epithelium-on C3R procedure, which is also known as transepithelial C3R, the corneal tissue layer of your eye is left intact.

The procedure can be combined with other treatments for the treatment of keratoconus. For example, C3R may be combined with intacs, which are tiny arc-shaped corneal inserts implanted in your eye to help stabilize and reshape the cornea in more complicated cases of keratoconus.

All symptoms, potential procedural/surgical options should always be discussed with your physician after a thorough consultation and examination  for an accurate diagnosis and treatment plan.

Results of the C3r Procedure

At Netram, 99 percent of patients remain stable or achieve improvement in their corneal shape in both epithelial-off and epithelial-on C3R. This success rate is significant for people who have progressive keratoconus that ordinarily leads to severe loss of vision.

Radial keratotomy has also achieved reasonable results in improving cornea stability. Radial keratotomy is an incisional refractive procedure that was popular from the 1980s and 1990s. Cross linking seems to work best for people who experience daily vision fluctuations.