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Post Info TOPIC: Crosslinking in the US with epi off?


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Date: Tue May 19 3:55 AM, 2009
Crosslinking in the US with epi off?
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My gf suffers from mild-moderate KC. We are currently evaluating our C3R options. We would ideally like to find a doctor in the US who performs collagen cross linking. Does anybody know of any opthamalogist who performs C3R with epithelium off in the US? Does anybody have any personal experience?

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Date: Tue May 19 1:08 PM, 2009
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I believe the only way that it is possible to get epi-off crosslinking in the US is to get screened for participation in the clinical trials. These are the US doctors who are participating in that trial.

Eric Donnenfeld, MD
Ophthalmic Consultants of Long Island
Rockville Centre and Garden City, NY

Dan Durrie, MD
Durrie Vision
Kansas City, KS

David Hardten, MD
Minnesota Eye Consultants
Minneapolis, MN

Peter Hersh, MD
Cornea and Laser Eye Institute
Teaneck, NJ

Marguerite McDonald, MD
Ophthalmic Consultants of Long Island
Rockville Centre and Garden City, NY

Francis Price, Jr., MD
Price Vision
Indianapolis, IN

David Schanzlin, MD
Shiley Eye Institute
La Jolla, California

Walter Stark, MD
John Hopkins University
Baltimore, MD

R. Doyle Stulting, MD, PhD
Emory University
Atlanta, GA

Stephen Trokel, MD
Columbia University
New York, NY

William Trattler, MD
Center for Excellence in Eye Care
Miami, FL


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Member

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Date: Tue May 19 1:11 PM, 2009
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However, I heard that at least one doctor in the study is referring patients out of the country if they are progressing rapidly and don't want to wait to get both eyes treated. I would still recommend contacting the doctor on the above list who is closest to you as a first step. Have them explain the study's parameters and protocol, and ask them what they would recommend if you want the fastest surest treatment.

Where are you located? We can perhaps put you in touch by private message with someone who has direct experience with one of these doctors.

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Member

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Date: Tue May 19 7:26 PM, 2009
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I am in the bay area and looking to get cross linking done ASAP. Could you help connect me with someone in the area or even outside the country?

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Senior Member

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Date: Wed May 20 2:49 AM, 2009
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Do a search using the forum search function, and then contact by PMing a active member that way, as then you can pick or choose more. It is best to stay close to home, so look for places which are close to the states.

Kane

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Date: Sun Aug 2 12:30 AM, 2009
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bochner eye institute here in toronto.4169602020.2700cad per eye. It is full epi-off treatment.

-- Edited by pereira951 on Saturday 1st of August 2009 11:31:41 PM

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Phase Two

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Date: Mon Aug 3 12:37 AM, 2009
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Here is a some science ! which is what we always go by more than most !!smilebiggrinsmile

Volume 35, Issue 3, Pages 540-546 (March 2009)

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Biomechanical and histological changes after corneal crosslinking with and without epithelial debridement

Gregor Wollensak, MDCorresponding Author Informationemail address, Elena Iomdina, MD

Received 24 June 2008; received in revised form 13 November 2008; accepted 15 November 2008.

Purpose

To test the biomechanical efficiency of corneal crosslinking with riboflavin without epithelial debridement (C3-R).

Setting

Moscow Helmholtz Research Institute of Eye Diseases, Moscow, Russia.

Methods

The left eyes of rabbits were crosslinked using standard crosslinking including epithelial removal (Group 1), using benzalkonium chloride–containing proxymetacaine eyedrops without epithelial removal (Group 2), or using preservative-free oxybuprocaine eyedrops without epithelial removal (Group 3). All left eyes received riboflavin solution and were irradiated with an ultraviolet-A double diode for 30 minutes (irradiance 3 mW/cm2). The animals were killed 1 day after crosslinking. Biomechanical and histological analyses were performed.

Results

Fourteen eyes were evaluated. There was a statistically significant increase in Young's modulus in Group 1 (102.45%) and in Group 2 (21.30%). In Group 3, no biomechanical changes were measured. Histology showed complete cell loss of keratocytes and endothelium in Group 1 and inhomogeneous keratocyte loss down to 200.0 m in Group 2. No changes were observed in Group 3.

Conclusions

Corneal crosslinking without epithelial debridement reduced the biomechanical effect by approximately one fifth compared with standard crosslinking, probably because of restricted and inhomogeneous stromal distribution of riboflavin. The cytotoxic damage was restricted to 200.0 m stromal depth, which is an advantage over the standard method. Therefore, C3-R is not recommended for the routine treatment of keratoconus but primarily for cases with a corneal thickness less than 400.0 m in which standard crosslinking cannot be used without serious risk to the endothelium.

From the Eye Laser Institute, Department of Ophthalmology (Wollensak), Martin-Luther-University, Halle, Germany, and Moscow Helmholtz Research Institute of Eye Diseases (Iomdina), Moscow, Russia

Corresponding Author InformationCorresponding author: Gregor Wollensak, MD, Wildentensteig 4, D-14195 Berlin, Germany.

Neither author has a financial or proprietary interest in any material or method mentioned.

PII: S0886-3350(08)01165-6

doi:10.1016/j.jcrs.2008.11.036

http://www.jcrsjournal.org/article/S0886-3350%2808%2901165-6/abstract


-- Edited by QuintriX on Sunday 2nd of August 2009 11:39:11 PM

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