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The treatment of C3-R® or Corneal Collagen Crosslinking with Riboflavin is a common practice. While there are several doctors that preform such a procedure not all of them believe that it can be done with the epithelium intact. However when the epi is removed it can cause pain and damage to the patient that may just very well be unnecessary.
The procedure -
Corneal Collagen Crosslinking with Riboflavin or also known as C3-R® is a procedure that involves using Riboflavin or Vitamin B2 to strengthen the corneal stroma in patients with Keratoconus, Corneal Ectasia, post-RK and some irregular progressing astigmatism. The procedure generally takes about 30 minutes. The doctor sometimes removes the Epithelium to help the drops get through to the stroma. Then a UV light is placed over the eye for around 30 minutes to activate the drops for effectiveness.
The Conflict-
Eberhard Spoerl Ph.D, From the University Eye Clinic of Dresden in Germany and Theo Silverman MD, at the Institute for Refractive and Ophthalmic Surgery in Switzerland have made a large impact on the procedure allowing it to gain Scientific research and studies. Their procedure involves what is called Epi-Off, this is when the Epithelium is removed to gain access to the corneal stroma. However Dr. Brian Boxer Wachler prefers to do the surgery free of removing the Epithelium giving the patient less pain hence the conflict. Dr. Boxer Wachler's technique involves disrupting the epithelium and pre-soaking the cornea for 5 minutes to allow penetration of the Riboflavin to the stroma prior to applying the UV light to activate the Riboflavin. Some doctors say that the procedure without removal of the Epithelium is not as effective. However studies have shown that after 30 minutes the drops hav
e fully absorbed and are activated by the UV light with the epithelium still attached. Dr. Boxer Wachler has been successfully treating patients with the Epi-on technique since 2004. 98% of patient's have needed on treatment and have had stabilization of the cornea with his Epi-on technique.
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“ When we and others have analyzed Epi-on vs Epi-off C3-R® results, there was no difference. It's no necessary to remove the epithelium if the doctor uses the technique of allowing the Riboflavin solution to penetrate through intact, but loosen the epithelium.” says Dr. Boxer Wachler.
The epi-on procedure allows the patient less discomfort afterwards, as well as avoids the scaring or hazed risk and the need for steroid drops after the procedure. It doesn't cause the side effects that the epi-off procedure does. Although there are still studies being conducted on this procedure it have been very effective in the Boxer Wachler Eye Institute. Just as Dr. Pinelli of the Italian Refractive Surgery Society or(SICR) who has visited the Boxer Wachler Eye Institute. He viewed the Epi-on procedure and preformed his first procedure on January 12th 2006. After his successful completion he has conducted multi-studies on the effectiveness of the Epi-on versus the epi-off procedure of the C3-R®.
Over the years Dr. Brian Boxer Wachler has continued to preform the epi-on versus the epi-off as he has made an oath to give is patients the best care possible and do no harm. He believes the Epi-off procedure could do harm by unnecessarily increasing the risk of scarring. To read more on the epi-on procedure visit: http://www.keratoconusinserts.com.
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