What’s the best way to cross-link the eyes of wheelchair users?

It can be challenging to cross-link the eyes of wheelchair users – for the patient and clinic staff alike. One example of just how challenging this can be is shown in a case report, recently published in the Journal of Refractive Surgery Case Reports (1), where a patient with Duchenne Muscular Dystrophy (DMD) required photoactivated chromophore for infectious keratitis-CXL (PACK-CXL) for the treatment of an infectious corneal ulcer.

People with DMD usually have great problems getting up from sitting or lying down and display Gower’s sign – an inability to get up thanks to weak lower limb muscles. Further, most people with DMD develop cardiomyopathy and respiratory impairment, which can result in reduced lung capacity when patients switch between sitting and supine positions. This is not an ideal situation when performing traditional cross-linking, where the patient would need to be transferred to a reclining chair, and receive up to 30 minutes of UV irradiation while lying on their back.

However, a new approach, cross-linking at the slit lamp, pioneered by Prof. Farhad Hafezi of the ELZA Institute in Zurich, allows CXL and PACK-CXL to be performed with the patient sitting upright at the slit lamp, using a portable, slit lamp-mountable cross-linking device called C-Eye. This approach was used by Dr. Boris Knyazer from Department of Ophthalmology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel, to successfully perform two PACK-CXL procedures over a 5-day period, on the eye of a 39-year-old wheelchair-using patient with DMD to treat infectious corneal keratitis. The procedure was simple: the patient simply maneuvered himself before the slit lamp to receive UV irradiation, avoiding the need to change position or risk compromising the patient’s lung capacity during the period of UV irradiation. This approach: CXL at the slit lamp can make any type of procedure to cross-link the eyes of wheelchair users easier, and potentially safer too.

To read the full text of the article, click here.


1. Knyazer B, Hillen M, Hafezi F. Corneal cross-linking for infectious keratitis at the slit lamp in wheelchair users. Journal of Refractive Surgery Case Reports. 2021;1(3).

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