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Epithelium-on corneal collagen cross-linking may speed visual recovery, minimize pain
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KIAWAH ISLAND, S.C. — A speaker here dispelled three widely held beliefs about corneal collagen cross-linking.
Patients older than 50 years with keratoconus can benefit from cross-linking, cross-linking with the corneal epithelium on may be as effective as the procedure with the epithelium off, and patients without progressive keratoconus can have strong visual outcomes, William B. Trattler, MD, said at Kiawah Eye 2012.
“Epi-on cross-linking can be as effective as epi-off,” Trattler said. “Age is not a factor in whether a patient is a good candidate for cross-linking. And don’t wait for progression. If you identify a patient with elevated eye pressure, you’re not going to wait for their optic nerves to get much worse before you institute glaucoma therapy. Same thing for keratoconus. Treat them with cross-linking. You can stop their progression even if it’s slowing and make them better.”
Epithelium-off cross-linking typically results in worse vision for 1 or 2 months, produces steeper keratometry, results in more haze, and increases the risk of infection and pain, Trattler said.
Epithelium-on cross-linking offers faster visual recovery with a return to contact lens wear within days, minimizes pain, reduces the risk of infection, and limits the development of corneal haze, he said.
Transepithelial cross-linking involves the use of topical tetracaine with benzalkonium chloride. Riboflavin drops are administered for 30 to 60 minutes; riboflavin saturates the entire corneal stroma.
Multiple investigator-initiated cross-linking trials are ongoing in the U.S. CXLUSA is conducting a prospective, non-randomized trial of epithelium-on and epithelium-off cross-linking at 15 sites. ACOS/Avedro has launched a 100-center clinical trial for cross-linking, Trattler said.
- Disclosure: Trattler is a consultant for CXLUSA.