Topography link C3R

Corneal Collagen Cross-linking with Riboflavin (C3R) with Topography Guided Laser Surface Treatment (C3R + Topo guided PRK) is a procedure that can be offered to those with early keratoconus.

Indications for Topography linked C3R
• Keratoconus
• LASIK induced ectasia
• PMCD-Pellucid Marginal Corneal Degeneration
We now perform treatments which combine C3R with an excimer laser surface treatment. We use the advanced Concerto excimer laser (WaveLight) for the topography-guided treatment.
This is only possible if the Corneal thickness is enough for both treatments and if the topography maps are found suitable for treatment.

Advantages of C3R combined with Laser Surface Treatment:
• Improves the corneal asymmetry.
• The synergistic improvement of shape, based on the C3R effect, allows us to reduce the laser treatment by approximately 50%.
• An improvement in visual acuity
• Better visual rehabilitation and improves vision with contact lenses and glasses by normalizing the corneal surface and reducing irregular astigmatism.
• Refraction remains stable for years.
• If the refraction is small enough, the total refractive error may be reduced
• Patients are easier to fit with contact lenses, which are also better tolerated than before.
• Increased functionality and eliminated need for corneal grafting or transplant are also benefits of the combined treatment.
Combining C3R treatment with a topography-guided treatment leads to better visual rehabilitation and improves vision by normalizing the corneal surface and reducing irregular astigmatism. A topography-guided surface treatment is followed by C3-riboflavin treatment.
We perform this topography-guided laser + C3R with epi-off. There is sometimes a mild initial post procedure haze, but it resolves with treatment.
This combined treatment has produced remarkable improvements in corneal Topography. The general changes produced during C3R + Topo guided PRK are flattening of the cone and improvement of the overall shape. This occurs because the combined treatment flattens the steepest area (ie, inferior) and steepens the flattest area (ie, superior).
Safety Issues
Recently, safety issues have been resolved and confirm that the endothelium, lens, and retina are not involved in any potential or real damage after the treatment.

There is some concern regarding the technique (ie, transepithelial treatment vs treatment with de-epithelization, which is doing C3R with Epithelium on or off?). We definitely advise with Epithelium off since there is no risk of damaging the retina or macula this way and a stronger cornea as the riboflavin is soaked into the cornea well.
This procedure has the necessary approval in Europe (CE) where it originated from.

Crosslinking of cornea using Accelerated C3R

C3R / CXL crosslinking

Talk to us today. A new world of natural vision could be waiting for you.
And read our FAQs on keratoconus / corneal collagen cross-linking.

* C3-R® is a registered trademark of Boxer Wachler Vision Institute