Epi-on versus Epi-off in cross linking

Abstract

We can say that Corneal CXL mediated by riboflavin and UVA appears to be a safe and efficacious procedure in halting the progression of keratoconus and iatrogenic ectasia. CXL reduces the corneal curvature, spherical equivalent refraction and refractive cylinder in eyes with corneal instability and progressive irregular astigmatism due to keratoconus and ectasia.

The CXL technique is promising in treating corneal melting conditions or infectious keratitis because cross- linking would strengthen a collagenolytic cornea while UVA irradiation eliminates the infectious agent. Combination of ICR implantation with CXL seems to have a synergistic effect for reverting the progressive irregular astigmatism due to keratoconus or iatrogenic ectasia. A sequential or simultaneous combination of limited topography-guided PRK and CXL, whose goal is normalizing the cornea as much as possible, shows promising results.

Clinical studies of CXL have shown great promise in stabilizing keratoconus and post-refractive surgery ectasia. While further randomized, prospective and long-term follow up studies are necessary, it is very likely that in the future corneal ectasia can be halted at an early stage and the need for rigid contact lenses and keratoplasty avoided. Future

refinement in techniques will allow for safer and more rapid procedure with less patient discomfort. Indications for