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

    Procedure can also be repeated safely, if necessary


    Keratoconus progression: the treatment debate

    Dr. Trattler, who is from the Center for Excellence in Eye Care, Miami, pointed out keratoconus can progress at any age and progression results in worsening of the patient’s refractive error and loss of BCVA. Even patients who have undergone implantation of corneal implants (Intacs, Addition Technology) and corneal transplants can experience progression of their keratoconus.  Interestingly, in Europe, where the epithelial-off procedure is performed, the standard practice is to wait for keratoconus to progress in adults before undertaking CXL.

    However, waiting may not be in the best interests of the patients, Dr. Trattler said. He shared a number of cases where keratoconus progressed markedly in as little as 3 months. In one case, for example, progression of keratoconus in a 63-year-old woman resulted in an increase in K values of + 4.4 D over a period of 4 years and 2 months.

    With the risk for progression being present for all keratoconus patients, one should consider crosslinking once a patient is diagnosed with keratoconus. Surgeons can expect that for many patients, crosslinking will not only stabilize the cornea, but will in fact lead to improvement in corneal shape and vision, he said. Dr. Trattler described the outcome in a 35-year-old woman treated with Epi-on CXL who, at 26 months postoperatively, had an improvement in Kmax values from 60.1 to 54.3 D, i.e., - 5.8 D.

    Following Epi-off CXL, the rate of progression after treatment was found to be about 3%, as reported recently by Antoun et al. in the Journal of Ophthalmology (2015; http://dx.doi.org/10.1155/2015/690961). If patients progress following CXL, one can repeat the CXL procedure, expecting the second procedure to typically be succesful at stabilizing the corneal shape.Epi-on CXL

    Transepithelial CXL (also known as Epi-on CXL) differs from the Epi-off procedure in that the epithelium is left undisturbed, leading to a more rapid healing time. A bandage contact lens is needed. However, a longer riboflavin loading time may be required to reach the desired end point.

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