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

    Procedure can also be repeated safely, if necessary


    In Dr. Trattler’s experience as part of a clinical trial sponsored by CXLUSA, administration of an optimized riboflavin with a delivery system resting on the corneal epithelium can result in sufficient riboflavin within the corneal stroma. The loading time can be as fast as 20 to 30 minutes. Work with other riboflavin formulations designed for Epi-on could take 1 or more hours to load. One important caveat is a required slit-lamp examination to verify the corneal stroma has sufficient riboflavin present prior to initiating the UV light.

    Dr. Trattler and colleagues conducted a study of Epi-on CXL to determine the procedure’s efficacy in patients with keratoconus, post-LASIK ectasia, and pellucid marginal degeneration and thin corneas ( < 450 µm) who had undergone the treatment either unilaterally or bilaterally with a pulsed light exposure time of 30 minutes. The patients evaluated were enrolled in the CXLUSA multicenter trial with sites in Florida or Maryland. The investigators evaluated the UCVA, BCVA, and Kmax values at 6 months and 1 and 2 years postoperatively.

    A total of 381 eyes were evaluated. The average patient age was 33.5 years. The average corneal loading time was 36.5 minutes. The average preoperative Kmax value was 63.5 D. The average preoperative Pentacam pachymetry value was 407 µm (range, 181-449µm). Of the study eyes, 80% had keratoconus, 17% post-LASIK ectasia, and 3% pellucid marginal degeneration, Dr. Trattler reported.

    The results indicated that there was progressive improvement in the Kmax values over time with subsequent improvements in the UCVA, BCVA, and astigmatism.

    At the 6-month follow-up visit, 206 eyes were recorded of which the average improvement in the UCVA was 1.71 lines and the average improvement in BCVA was 0.68 lines, Dr. Trattler said.  The average Kmax improvement from the baseline value was 0.75 D of flattening and the average decrease in the refractive astigmatism was 0.3 D.

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