C3R / CXL Surgery In Delhi

Yes — C3R (Corneal Collagen Crosslinking with Riboflavin) and CXL (Corneal Crosslinking) are the same procedure. C3R is the name commonly used in India; CXL is used internationally. Both refer to the use of riboflavin (Vitamin B2) eye drops combined with UV-A light to create new covalent bonds between corneal collagen fibres, stiffening and strengthening the cornea to halt keratoconus progression.

No — C3R does not cure keratoconus or reverse the existing cone shape. Its sole purpose is to stop the disease from progressing further. Think of it as putting keratoconus on pause. The irregularity and astigmatism already present in your cornea will remain — though some modest improvement in corneal shape and vision is seen in approximately 40–50% of eyes over the following 1–2 years. Glasses, RGP lenses, or scleral lenses will still be needed for vision correction after C3R.

Yes — in most cases. C3R stabilises the cornea but does not reshape it. Your glasses or contact lens prescription may remain similar, improve slightly, or occasionally worsen transiently during healing (3–6 months). Once the cornea is stable at 3–6 months, your prescription can be finalised. RGP or scleral contact lenses are often the best optical solution for keratoconus — even after C3R — and our team will guide you on the best option for your vision.

Progression is documented by serial Pentacam corneal tomography scans performed 6–12 months apart. Any of the following indicate progression: Kmax increase of ≥1.00D, manifest cylinder increase of ≥1.00D, spherical equivalent change of ≥0.50D, or increasing posterior corneal elevation on Pentacam. If you do not have a prior Pentacam for comparison, we may ask you to return in 3–6 months for a progression check before recommending C3R.

The standard safety threshold is 400 microns corneal thickness after epithelial removal. Below this, the UVA may penetrate to the corneal endothelium (the inner cell layer) and cause irreversible endothelial damage. For thin corneas between 350–400 microns, hypotonic riboflavin (which causes corneal swelling) can be used to temporarily increase thickness above 400 microns before UV-A irradiation, extending the candidacy of C3R to thin corneas.

The eye drop anaesthesia numbs the corneal surface effectively. The most uncomfortable moment is epithelial removal — patients describe it as mild scratching, not pain. During UV-A irradiation, the eye is numb and you simply look at a fixation light. After the procedure, when the anaesthetic wears off (2–3 hours), there is significant surface discomfort — like a foreign body sensation and photophobia — for 24–48 hours while the epithelium heals. Prescribed pain relief drops and oral analgesics manage this well.

Epi-off C3R removes the corneal epithelium before applying riboflavin, allowing full penetration into the stroma and producing a deep demarcation line (200–300 µm). It is the gold standard with the strongest 10-year efficacy data. Epi-on (transepithelial) C3R keeps the epithelium intact — reducing pain and recovery time but producing a shallower crosslinking depth (100–150 µm) and less consistent progression-halting results in published studies. At Netram, we perform Epi-off because we prioritise efficacy — C3R should work fully the first time.

Yes — bilateral same-day C3R is safe and routinely performed at Netram. Both eyes are treated with separate instruments and riboflavin vials. The advantage is fewer procedure visits and hospital trips, which matters greatly for young working patients or those travelling from outside Delhi. The consideration is that during 3–5 days of epithelial healing, vision in both eyes will be reduced — patients are counselled to take leave from work or school and arrange assistance during this period.

Most patients return to desk work and school within 5–7 days, once the bandage contact lens is removed and the epithelium has healed. Screen work and reading are comfortable again at 1–2 weeks. Contact sport, swimming, and dusty environments should be avoided for 4–6 weeks. Glasses or contact lenses may be worn once the epithelium is fully healed (Day 5 onwards for glasses; contact lenses after 4 weeks minimum and only with doctor clearance).

C3R is priced at ₹35,000 per eye at Netram Eye Foundation, Greater Kailash II. Bilateral package pricing is available — please contact our team for the current both-eyes rate. The price includes pre-operative Pentacam evaluation, the C3R procedure, bandage contact lens, post-operative medications for the first week, and all scheduled follow-up visits up to 6 months. Cashless insurance and EMI facilities are available.