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Technique utilisée : CXL standard de Siena (protocole Wollensak) / CXL accéléré
1. Installation et anesthésie
– Décubitus dorsal, champ opératoire stérile
– Anesthésie topique : collyre oxybuprocaïne 0,4 % – 3 instillations à 5 min d'intervalle
– Blépharostat mis en place
2. Désépithélialisation
– Décollement épithélial mécanique à l'éponge ou à la spatule sur une zone centrale de 8–9 mm de diamètre
– Vérification de la qualité du décollement sous microscope opératoire
3. Instillation du photosensibilisant
– Riboflavine 0,1 % (solution isotonique / hypoosmolaire) instillée toutes les 3 minutes pendant 30 minutes
– Vérification de la pénétration stromale et de la flare en chambre antérieure
4. Irradiation UV-A
– Source UV-A : longueur d'onde 365–370 nm
– Irradiance : 3 mW/cm² × 30 min (dose totale : 5,4 J/cm²)
OU : 9 mW/cm² × 10 min (protocole accéléré – dose totale identique)
– Riboflavine maintenue toutes les 3 minutes durant l'irradiation
– Distance source-cornée : 5 cm
5. Fin d'intervention
– Rinçage abondant au BSS
– Mise en place d'une lentille de contact pansement (LCP) : …… D, diamètre …… mm
– Instillation d'une goutte d'antibiotique (fluoroquinolone) et d'un AINS topique
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