EpiOn EpiOFF CrossLinking
Why are so many people so averse to removing epithelium for CXL? Is this a religious prohibition or something?;)I remember assisting retina surgeons at Harvard/MEEI (including my uncle) and they’d remove epithelium at the slightest excuse for a better view. There are PRK and ASA surgeons out there who are doing this thousands of times each and every year without delayed healing, pain, or scarringSo I’d like a response from the surgeons who are trying so hard to make epi-on CXL approach the proven efficacy of epi-off CXL, why they’re so averse to removing epithelium, when with a clean en-bloc epithelial removal, a proper BCL, and the right postop meds, there’s no pain and almost zero risk of infection?I’d like to restate a query nobody responded to:Why spend so much effort on such a limited application (CXL) when if all of us spent that time optimizing epithelial regrowth, that’d be more useful in a number of eye surgeries literally 100,000x as numerous?—Emil William Chynn, MD, FACS, MBA
If the outcomes are the same – what is the advantage of removing the Epithelium with CXL?
In our study – when patients have Epi-On CXL
1. Patients are able to return to work 1-2 days after their procedure
2. The risk of infection is exceptionally low.
3. One of the risks with Epi-Off CXL is corneal haze – and this risk is dramatically reduced with Epi-ON
4. Patients do not need a bandage contact lens
5. Patients can return to their RGP, scleral or soft toric contact lenses 2-3 days after their procedure
6. There are fewer office visits. After the 1 day postop visit, there is no need for a second visit – other than to monitor changes. So in our protocol, we have patients return at 3 months. With Epi-Off – patients would need a visit a 5 days postop to confirm that their epithelium has healed. These are steep corneas, so epi healing can take longer in some patients, requiring additional visits
7. Less steroids are needed with Epi-ON – since the risk of haze is dramatically lower than with Epi-Off
These are just a few advantages. Again – in our study, when confirming there is sufficient riboflavin in the corneal stroma prior to UV light administration, we have had excellent results.