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Post Info TOPIC: Epi-On CXL


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Date: Sun Feb 28 12:52 PM, 2010
Epi-On CXL
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At the recent ESCRS meeting in Budapest I was introduced to RICROLIN®TE (riboflavin 0.1% + enhancer). This is the first transepithelial formulation certified for corneal cross-linking in Europe. Sales reps said that it will be available within the next few months.

Peter
drgoren@hotmail.com


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Date: Mon Mar 1 3:58 AM, 2010
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Thanks for letting us know Dr Goren, it means a lot to us every post you make, we hope you go right to the top in eye care !

This "thinner" B2 solution makes crosslinking the holy grail in treatment - as crosslinking even though not invasive is now not a surgery at all ! and is the only treatment for KC progression ...Brilliant !!

Thank you once again Dr Gorgen, some day all Drs will be like you ! smile

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Date: Tue Mar 2 3:07 PM, 2010
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dr Goren, can you please give us some details on this product? Thank you!

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Date: Tue Mar 2 4:56 PM, 2010
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Hi, am I understanding it correctly? Should CXL epi on with this solution go as deep as epi off and be as effective? If so it would be great, cause epi off wasnt the nicest thing i did and i think i got a little miniscar from the scraping.

Br Henrik.F

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Date: Wed Mar 3 12:06 AM, 2010
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OCULAR SURGERY NEWS EUROPE EDITION September 1, 2009
Corneal cross-linking shows increasingly good results, gains popularity, stimulates research

....One step of the procedure that is still controversial is the initial removal of the epithelium. Most surgeons agree that removing the epithelium is a necessary step for riboflavin absorption.

"The corneal epithelium represents a barrier for the molecules with molecular weight greater than 100, and riboflavin’s [molecular weight] is more than three times that," Prof. Seiler said. "The question is, at this point, whether abrasion is the only way to make riboflavin go through this barrier or whether there are better alternatives."

"We always remove the epithelium for better efficacy," Prof. Colin said. "However, Sooft is now producing a new riboflavin preparation with modified physiochemical properties that will be able to penetrate the cornea through the epithelium. This will result in better comfort for the patient."

A study on transepithelial cross-linking with the use of this new Ricrolin TE (transepithelial) is beginning in Italy at the University of Siena.

"The procedure will be performed in 10 keratoconus patients already selected for corneal transplantation. After surgery, the removed tissue will undergo immunology testing and confocal microscopy observation to assess the safety, depth and efficacy of the cross-linking treatment," Prof. Caporossi said.

According to Aylin (Ertan) Klç, MD, an effective way of doing epithelium-on procedures is by impregnating the corneal surface with a 20% alcohol solution for 25 seconds.

"Alcohol breaks the tight junctions of epithelial cells, so the epithelium is no longer a barrier to riboflavin penetration," Dr. Klç said.

There are several advantages in leaving the epithelium on, she said. Healing and visual rehabilitation are faster, and the patient experiences no pain. In addition, the risk of complications is significantly lowered.

"Most of the complications of cross-linking are due to removal of the epithelium," Dr. Klç said. “In addition, the studies on riboflavin penetrations were conducted on porcine eyes, which have a thicker epithelium than the human keratoconic eye."


The full article is available below:

http://www.osnsupersite.com/view.aspx?rid=42778



The handout I received at the conference says the following:

Advantages of transepithelial cross-linking:

- Does not necessarily need to be performed in the theatre

- The procedure can be performed even on corneas with a thickness of just under 400 microns

- Facilitated preparation of patient for radiation treatment

- No deterioration in post-procedure sight compared to pre-procedure

- Excellent patient compliance

- No post-treatment pain

- No complications associated with the removal of the corneal epithelium

Conclusions:

Data currently being published regarding the use of RICROLIN®TE on a group of keratoconic patients demonstrates:

- improvement in topographic situation (follow-up at 9 months)

- no side effects (a slight feeling of the presence of a foreign body and moderate conjunctival hyperaemia were only rarely experienced during the first 6 hours post-treatment)

- no post-treatment pain

- no variation in corneal transparency

- rapid return to work

http://www.oogroup.it/oftaht/en/md_ricrolin_te.html



Peter
drgoren@hotmail.com


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Date: Thu Mar 4 1:23 AM, 2010
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That's great news, I hope we are able to have more results on that, it sounds quite interesting

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Date: Sun Mar 7 8:19 PM, 2010
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Hi niice! thanks that sounds great, think i will put my good into that if it works as expected:) would be so nice to know that it stopped for sure, now i dont know since the other eye was stable for 5 years and suddenly progressed fast without any reason.

Do you think that CXL epi on if it works will be used as prevention on seeminly stable KC too?

I mean now my doctors say they want to see atleast 1D astigmatism to the worse, that could mean quite alot vision degradation if the ghosting and stuff also increases.

Br Henrik.F


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Date: Wed Mar 10 3:10 PM, 2010
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I think we need to wait for more results and especially long-term results before cross-linking preemptively. Cross-linking may change the topography slightly. If this new method has less of an effect on topography it may be used earlier. I don't think there will be a clear view on this. Doctors opinions and recommendations are likely to vary as well.

Peter
drgoren@hotmail.com

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