All of us Vs Keratoconus

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Post Info TOPIC: Help on cross linking!!


Status: Offline
Posts: 1
Date: Tue Sep 16 7:05 AM, 2014
Help on cross linking!!

Anyone been to Brian Boxer Wachler in Cali? Many claim he is really good but its a epi on cross linking and many say epi off is better. I really would prefer to do epi on. Can anyone help me and share experiences? Nerve racked over this.


Veteran Member

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Posts: 41
Date: Thu Sep 3 6:24 PM, 2020

This link here clears this up

We are all patients or will be (!) So put patients first!

Senior Member

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Posts: 101
Date: Fri Sep 4 11:12 PM, 2020

This study also makes a clear distinction of the two:


Epithelium-Off vs. transepithelial corneal collagen crosslinking in progressive keratoconus: 3 years of follow-up

Under a Creative Commons license
open access


To compare the efficacy of epithelium-off corneal collagen crosslinking (CXL) with transepithelial CXL in patients with progressive keratoconus with a follow-up of 3 years, taking into account the patients’ age and the location of the corneal ectasia.


In this prospective study participated 64 eyes with progressive keratoconus were included in this long-term study, of which 31 eyes were treated by epithelium-off CXL and 33 by transepithelial CXL. All of the patients with a follow-up of 36 months were evaluated for visual variables (corrected distance visual acuity (CDVA), corneal aberrations, and corneal densitometry), structure variables (astigmatism, keratometry, corneal asphericity, maximum posterior elevation, corneal thickness, and corneal volume), and keratoconus index variables.


After corneal CXL, CDVA improved significantly in both central and paracentral keratoconus, with greater improvement in the centrals (p=0.001), asphericity at 6mm improved in central keratoconus (p=0.047). In the epi-off group, there was a significant improvement in coma-like (p=0.038), higher-order aberrations (p=0.036), asphericity at 8mm (p=0.049), asphericity at 10mm (p=0.049), and index of surface variance (p=0.049).


Although both techniques halted and stabilized the progression of keratoconus, epithelium-off CXL was more effective. In addition, after the corneal CXL, there was a greater degree of regularization of the corneal surface and, therefore, a greater improvement in the CDVA with central keratoconus than with paracentral keratoconus.

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