Epithelium off Cornea collagen cross linking (CXL) is not voodoo. We realize that early in new technology a lot of unfounded claims like epi on CXL being Better than epi off might be made. It behooves us clinicians to present proof to peers.
There is a symbiosis between diagnostic technology and treatments. We will take help of Carl Zeiss Ocular coherence tomography to demonstrate the effectiveness of epi off CXL.
Here is a High Density picture of a keratoconus cornea before any treatment. It is early keratoconus in a young girl. This is the best time to intervene to treat Keratoconus. Look how uniform the picture is. The top layer of epithelium can be clearly seen. We remove this layer with laser or as Professor Theo Seiler recommends with ethyl alcohol.
Epithelium prevents riboflavin from entering the stroma and hinders the UV absorption. Look at the picture below. You can clearly see a haze which ends around 80 % depth as a line of demarcation.
The same line of demarcation after cornea cross linking is better highlighted in they colored OCT of the Cornea.
If you are suffering from Keratoconus Call 805-283-6520 to see if cross linking of cornea is the best option for you.
BMW on the autobahn is a hair rising experience. Now our German friends want to bring that concept to cxl or corneal cross linking. You may have heard of accelerated cornea cross linking? This is cxl with 10 minutes of UV radiation treatment, In the newest version they propose treatment of only 5 minutes utilizing 18 mw/cm2 of UV radiation.
This would of great benefit to patients. The amount of time they have to stare at the blue light would decrease. Exposure of the cornea to the elements would be less.
We would like to quote the results of the study here ” The mean follow-up time was 21.7 ± 7.2 months (range, 12-34 months). No statistically significant changes were found in the mean corrected distance visual acuity, corneal astigmatism, Kmean, Kflat, Ksteep, corneal pachymetry (at the apex and at the thinnest point), and corneal densitometry at follow-up. A significant reduction of Kmax, index of surface variance, index of vertical asymmetry, and Km of the posterior corneal surface (Km(B)) was observed (Kmax: P = 0.018; index of surface variance: P = 0.016; index of vertical asymmetry: P = 0.038; Km(B): P = 0.008). No complications were reported during the postoperative follow-up period in this study.”
Our question for the authors are. 1) How deep was the demarcation line?
2) was any comparison made to conventional cross linking?
Other papers or followup studies should be address the questions.
Dr.Khanna is a Keratoconus Expert. These informative blog posts are for information purposes. They should not replace a careful discussion with you Keratoconus Eye surgeon.
Keratoconus eye disease is no laughing matter. It afflicts teens and can destroy careers. We need to accelerate our fight against this vicious disease. At the same time we have to study scientifically the newer protocols. Accelerated cross linking speeds the treatment by decreasing the time of exposure of UV light. This has recently been studied in pediatric keratoconus.
This landmark study from Hong Kong By Surgeons of Royal college is a landmark one. It shows that accelerated cornea cross linking slows the progress of the bulging eye disease. it is the first one to document that only conventional cornea cross linking with its deep demarcation line can actually flatten the cornea. In essence it means that the 30 min api off intervention can halt the progression as well as reverse some of the effects.
The deeper the demarcation line the more the cornea flattening .
Keratoconus Experts in Los Angles thank the authors to bring new meaningful data for mutual benefit.
A new study in journal of cataract and refractive surgery increases our knowledge of cross linking in keratoconus patients. Cross linking, as you may recall is a newer treatment for bulging cornea. The strength of the cornea is increased by adding riboflavin and activation it by UV radiation. This affects the nerves in the cornea.
This study on keratoconus patients undergoing cross linking compared the return of corneal sensation. It divided the patients into two groups. One group had epi off cross linkage and the other had epi on cross linkage.The Keratoconus experts analyzed the results. They came to the conclusion that the nerve sensation recovered in both methods. The recovery was faster in pi on or transepithelial corneal cross linking.
Currently the most efficous method for corneal collagen cross linking is the epithelium off Dresden protocol. Research in cross linking is further needed to make epithelium on more beneficial as it has quicker recovery and less patient discomfort.
Each individual eye is different. A keratoconus surgeon can discuss with you which treatment protocol would be best for your eye.
Hi Keratoconus patients, doctors, Keratoconus experts and sympathizers
You will be all glad to know that our popular information portal is getting a overhaul. Technology upgrades and hacking had created problems with the discussion forum. Good news . That is going to be back in the next few weeks.So check back frequently.
We have a lot of information on Keratoconus on our portal. One of our first keratoconus sites gives an overview of keratoconus and its management.
http://www.Newintacs.com is focussed on causes of keratoconus. It delves in detail on history of progression, pathology, biochemistry and evolution on knowledge of the disease process.It provides information on affording these cutting edge treatments.
Now we are soon going to launch an entire site focussed on treatment of keratoconus Surgical treatments of keratoconus using advanced lasers will be presented. Age based appropriate cures will be shown. Each procedure will be accompanied by pictures and videos of surgeries. Patient feedback in form of written reviews, videos will be highlighted.
And a surprise…if you get bored by static sites, we have a smart genie that can interact with you to guide you to the answers you seek in the treatment of keratoconus
all coming soon.
will keep you updated
Keratoconus as we have been reading on this site about keratoconus is a weakening of the cornea affecting quality vision. Cataracts, on the other hand affects the lens of the eye. It occurs when water enters the natural lens affecting its transparency. Our own Beverly Hills Keratoconus Expert Dr Khanna says” Cataract is a disease of older age where as Keratoconus occurs in childhood and youth.When a keratoconus patient grows older he ay develop cataract”. The problem in curing cataracts with keratoconus is finding a good surgeon proficient in Laser cataract surgery. The lens to replace the opacified natural lens. Two problems are faced by Los Angeles Cataract specialists treating Keratoconus patients suffering from cataracts. The first challenge is to get keratometry reading or the shape of the cornea.This is used in formula like srk-t or holladay. These mathematical expressions presume the front clear surface of the eye or the Cornea is round. In keratoconus as we know the cornea is of an abnormal shape. Many a time there are folds in the cornea, the epithelium is thickened. Sometimes the cornea with keratoconus may even have an opacity.
The second challenge in treating cataracts in keratoconus patients is choosing a good intraocular lens replacement. Toric lens could be helpful in such situations. Toric lens have astigmatism built in them.
A cornea trained surgeon who is adept at complicated cataract surgery is the best person to handle your procedure if you are suffering from keratoconus and Cataracts. You are lucky that in Los Angeles area we have one. Dr. Khanna an expert in cataract surgery with lasers and treatment of keratoconus should be your choice to help you see better.
A question which has been posed to us by one forum member is related to the use of cell phones. Smart phones have proliferated and we have i phone, android phones and the like. These phones may emit radiation. So logical question is can they move the newer intacs or worsen the keratoconus disease. We do not know of any study which point to this. If you analyze the pathophysiology of the disease,you will realize it is due to lack of bonding between the collagen fibrils of the cornea.Radiation has not been shown as a causative factor. Cell phones wilL therefore not have any effect. Still, lets use caution, for who knows what studies 30 years from now will show.