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    Epi-on CXL: Safe, effective option for treating thin corneas

    Procedure can also be repeated safely, if necessary

    Take-home: Patients with thin corneas as the result of keratoconus, ectasia following LASIK, or pellucid marginal degeneration can safely undergo epithelial-on collagen crosslinking with pulsed UV light and achieve visual benefits from the procedure.

    Reviewed by William Trattler, MD

    Miami—Patients with thin corneas as the result of keratoconus, ectasia following LASIK, or pellucid marginal degeneration can safely undergo epithelial-on collagen crosslinking (Epi-on CXL) with pulsed ultraviolet (UV) light and achieve visual benefits from the procedure, according to William Trattler, MD.

    CXL has been shown to stop progression of keratoconus and stabilize the corneal shape in a high percentage of patients. CXL can also improve both the uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) levels in many patients with ectatic corneal disease.

    The FDA approved Epi-off CXL on April 18, 2016, based on numerous trials of the technology in the United States and internationally. However, while Epi-off CXL has a long track record with positive outcomes, there is still room to advance the CXL treatment.  One area of focus is optimizing the delivery of riboflavin so the epithelium does not need to be removed. Other areas of focus include increases in UV energy, which can allow for shorter treatment times, as well as pulsing of the UV light. Overall, the current FDA-approved CXL technology works well for patients with keratoconus and post-LASIK ectasia, but there is room for further innovations,  Dr. Trattler said.

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