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    Strategies for starting a CXL practice

    Corneal crosslinking (CXL) is a minimally invasive procedure that is safe and associated with few complications when the procedure is performed with proper precautions. Because adverse events can still occur, surgeons performing this procedure must also be comfortable managing potential complications, said Clara C. Chan, MD.

    Dr. Chan presented pearls for preventing common CXL complications and strategies for managing complications if they arise.

    Understanding the problems that can occur is the basis for identifying pre-emptive techniques. They involve preoperative, intraoperative, and postoperative interventions.

    To prevent delayed epithelial healing and haze, Dr. Chan said it is important to optimize the ocular surface prior to treatment

    “A lot of patients who need CXL have vernal or atopic keratoconjunctivitis and these diseases should be very quiet before performing CXL,” said Dr. Chan, lecturer, department of ophthalmology and vision sciences, University of Toronto, Ontario, Canada. “The ocular surface must also be optimized in patients with severe dry eye, and don’t underestimate the danger rosacea can cause. These patients are notorious for having peripheral ulcerative keratitis and melt, even after simple cataract surgery.”

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