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CXL and epi-off?



I am a member of the large keratoconus group on Facebook.  I dont really post much, but its interesting to read what patients with this condition are writing about.  Granted these are lay people, but often someone with a disease learns a lot about it.

There is a constant ongoing debate about epi-off vs epi-on.  Someone decides to get CXL for their kid, the surgeon does it one way, and then they start reading that maybe the other way is better(and this can go either way).

So, is there a consensus yet?  Is one method now preferred over another?



Epi-off is more proven

All studies show epi-off is more effective

Or the same effectiveness as epi-on

No studies show epi-on is more effective

Because some surgeons have had problems with delayed re-epithelialization and subsequent pain or rarely infections or scarring, many are calling for research to make epi-on as efficacious as epi-off (eg via iontophoresis)

I say it’s much easier trying harder to get the epithelium to grow back faster

It’s possible that surgeons who have more experience dealing w epi removal and regrowth (eg those performing a lot of lasek and PRK) are the ones having faster healing after epi-off cxl

And the ones who don’t have as much experience (like those only performing lasik) are the ones with longer healing times after epi-off cxl, who then move to epi-on

Anyway, that’s my summary, and 99% of eye surgeons would agree with the first half, and the majority (>50%) might agree with the second half;)

Hope this helps!

Emil William Chynn, MD, FACS, MBA


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