Eyeworld

Uniform epithelium removal in 5 - 7 seconds Corneal Xlinking, PRK Advanced Surface Ablation Improved clinical outcomes of CXL and PRK with Amoils Epithelial Scrubber Visit us at AAO 2017 in booth # 553 Minimize total procedure time Avoid alcohol damage to surrounding tissue No need for subsequent scraping T. 800.461.1200 www.innovativexcimer.com order online www.innovativexcimer.com AMOILS EPITHELIAL SCRUBBER AMOILS www.innovativexcimer.com and the delivery of supplemental oxygen to the stroma using oxygen goggles. It's very exciting research and is important for the refractive applications of crosslinking, such as the PiXL procedure." 3 He noted that the epi-off meth- od has been firmly established to be both safe and effective and is the global standard of care for the treat- ment of progressive keratoconus. "In patients with progressive disease, discomfort associated with removal of the epithelium is far outweighed by maximizing the potential to pre- serve visual function. Patients may come into the hospital with an idea of which procedure is preferable, but in the end, it is our responsibility to provide the procedure that is best for their long-term disease prog- nosis. The peer-reviewed literature suggests that there are greater rates of progression with currently studied epi-on techniques," he said. Epi-on Doyle Stulting, MD, PhD, Atlanta, is a strong proponent of the epi-on method. He began performing cross- linking in 2008 using the classical Dresden technique. "The data we produced from the study in 2008 went toward obtaining approval for Avedro for that technique. We also ran a clinical trial for Topcon [Tokyo, Japan] with a similar proto- col," he said. In October 2013, Dr. Stulting be- gan working with a protocol devised by CXL-USA, which is a physician- sponsored, prospective research effort underway at 13 sites across the country. The CXL-USA protocol gives the surgeon the freedom to choose the epi-on or epi-off tech- nique, and most of the investigators in CXL-USA choose epi-on. "Epi- on is all I have done since October 2013. With that protocol, we have been obtaining results that are equal to or better than what has been ob- tained with the epi-off protocol, the classical Dresden protocol, in our hands and in others. We are prepar- ing those data for publication," Dr. Stulting said. He has observed better ribofla- vin penetration and better riboflavin concentrations in the stroma using the epi-on protocol than could be obtained with the classical epi-off technique, as approved. "Because there are complications related to epithelium removal, which can include corneal scarring, infec- tious keratitis, and non-infectious ulceration, epi-on is much safer. In addition, patients experience a return to preoperative visual acuity in 2 to 3 days instead of as long as 2 to 3 months. Patients report good comfort in 1 day rather than 1 week. Additionally, there is no epithelial defect postoperatively, except rarely on postoperative day 1. So surgeons do not need to see patients during week 1. Contact lenses and pain medication are not required past day 1. We can also treat comfortably bilaterally instead of unilaterally," Dr. Stulting said. According to Dr. Stulting, an- other benefit to this technique is re- duced time. "The loading time with riboflavin varies depending on the individual. There are some predic- tive factors that determine riboflavin loading time, which we are looking at now for publication. We are able to saturate the cornea in 10 minutes, frequently, rather than 30, as is done with the classic technology. From a patient flow standpoint, we can get a patient in and load the cornea in 10 minutes, expose him or her to ultraviolet light for 30 minutes, and be finished with two eyes inside of 45 minutes, with discomfort for 1 day and return to good visual acuity in 2 to 3 days. With the classic tech- nique, treating one eye takes at least an hour, and we can only treat one eye at a time," he said. EW References 1. O'Brart DPS. Corneal collagen crosslinking for corneal ectasias: a review. Eur J Ophthal- mol. 2017;27:253–269. 2. Shalchi Z, et al. Safety and efficacy of epithelium removal and transepithelial corneal collagen crosslinking for keratoconus. Eye (Lond). 2015;29:15–29. 3. Elling M, et al. Photorefractive intrastro- mal corneal crosslinking for the treatment of myopic refractive errors: Six-month interim findings. J Cataract Refract Surg. 2017;43:789–795. Editors' note: Dr. Stulting has finan- cial interests with CXL Ophthalmics (Encinitas, California). Dr. Elling has no financial interests related to his comments. Contact information Elling: Matthias.elling@kk-bochum.de Stulting: dstulting@woolfsoneye.com

• Blank Page
• Blank Page (1)