MEGARIDE – the latest cross-linking technique for treating keratoconus

Until now, obtaining the full effect from the treatment involved removing the epithelium of the cornea before applying riboflavin and irradiating with ultraviolet radiation.

The cross-linking procedure without removing the epithelium (epi-on) is more beneficial for the patient, because it is quicker and more convenient.

There is no post-operative pain, and the eyesight returns to normal faster.

There is also a lower risk of post-operative complications, such as corneal inflammation or delayed healing of the epithelium.

In addition, the operation can be carried out on a cornea a mere 350µm thick!

When using the standard procedure, the thickness of the cornea must be at least 400 µm.

Long-term observations have proven that this treatment is not fully effective, however.

Visual examinations have shown that after the operation, changes to the proper substance of the cornea were far more superficial than in the case of the standard (epi-off) procedure.

So in effect, several patients displayed progress in the keratoconus after applying the epi-on technique.

Data from clinical trials shows that half of patients under the age of 26 who were subjected to epi-on cross-linking had to undergo a further cross-linking operation using the standard technique.

The latest procedure according to the MEGARIDE protocol combines the benefits of both the epi-off and epi-on procedures.

It does not require removal of the epithelium of the cornea, and the post-operative effects are like those of the epi-off procedure.

How is this possible?

The first key to success is the unique riboflavin formula – Ribocross TE – which contains vitamin E. This allows it to freely penetrate through the undamaged, hydrophobic epithelium of the cornea, obtaining a greater concentration in the proper substance of the cornea.

Another innovation of the MEGARIDE protocol is the modern UV CF X-LINKER lamp.

This enables the dose and irradiation time to be matched individually to each cornea.

Before the operation commences, data concerning the cornea which is the subject of the procedure is entered, such as its thickness and bulge, and the system uses mathematical formulae to establish the appropriate dosage of radiation, i.e. the time and strength of the UVA and the diameter of the irradiated area.

The procedure lasts around 25 minutes, including 15 minutes applying the riboflavin and 10-15 minutes of irradiation.

There is no need to wear a bandage contact lens after the treatment.

During the post-operative period there is no pain, discomfort or major deterioration of vision.

Anti-inflammatory eye-drops should be applied for around two weeks.

The cross linking procedure first used in the 1990s has been improved many times.

The new method which we have implemented at the Laser Eye Microsurgery Centre has turned out to be the most effective modification in the history of this procedure.