Clinical experience
In recent years, corneal cross-linking has become the standard procedure for treating patients with progressive keratoconus and other ectatic corneal diseases because of its effectiveness and lack of serious side effects.

In a number of clinical studies it was demonstrated that in more than 85% of eyes treated, the BCVA increased significantly. Six months after the procedure, cylinder was reduced in the majority of all patients. The steepest K-value was reduced by an average of up to 2 dioptres.

Background
Corneal cross-linking is a process of photopolymerisation. During this process of photopolymerisation, singlet oxygen is being created with the use of riboflavin as a photomediator activated by UV-light. Free radicals lead to physical intra- and interhelical cross-links of stromal collagen fibers. This process takes place mainly in the anterior 150 μ of the stroma. This is important to remember in cases where a refractive procedure is planned post-CXL.

The device
The CCL-VARIO corneal cross-linking system was designed with a special focus on effectiveness, safety and user friendliness.

It comes with 1 diode and special optics which is homogenising the beam. Thus, hot spots are being avoided and the endothelium is sufficiently protected.

To offer more flexibility, it enables the surgeon to choose between 3 energy levels: 3 mW, 9 mW and 18 mW.

This allows the surgeon to choose the ideal energy/time combination for the intended treatment: Standard – Accelerated – Express Cross-linking. At the end of the procedure the system switches off automatically.

• 3 mW x 1,800 sec (30 min) = 5,400 mJ
• 9 mW x 600 sec (10 min) = 5,400 mJ
• 18 mW x 300 sec (5 min) = 5,400 mJ

Since the total dose of radiation is time dependant, each setting delivers a total energy of 5,400 mJ.

Studies performed by Prof. Eberhard Spoerl, PhD at the University of Dresden demonstrated that the amount of cross-links achieved by various energy levels is practically the same.

To guarantee a high level of safety, the beam of CCL-VARIO has a wasteline at a distance of 45mm from the optics and a depth of focus of approximately +/- 5mm.

To protect the limbal stem cells and to focus the beam on the clear cornea only the CCL-VARIO has a continuously adjustable aperture from 7 mm to 11 mm.

CCL-VARIO
The CCL-VARIO is portable with a table mount and comes in a sturdy transport case allowing the surgeon to be mobile.