Corneal Cross-Linking: Epi-Off Versus Epi-On Versus Epi-Partially-Off Techniques Publisher



Mohammadpour M¹ ; Khorraminejad M²
Source: Keratoconus: Optical and Surgical Management Published:2024

Abstract

Keratoconus is a progressive, non-inflammatory thinning disorder of the cornea characterized by corneal protrusion and irregular astigmatism. Corneal cross-linking (CXL) has emerged as a promising treatment for halting the progression of keratoconus and corneal ectasia. It involves using riboflavin eye drops and ultraviolet-A irradiation to strengthen corneal collagen fibers and increase corneal rigidity. The standard CXL protocol involves removal of corneal epithelium (epi-off) to allow penetration of riboflavin into the stroma. However, epi-off CXL has limitations like post-operative pain, risk of infection, and delayed wound healing. However, Nicula et al. reported that “epi-off”-accelerated and conventional CXL have the same effect on topographic and visual outcomes. 1 In this chapter, we begin by reporting the epi-off and epi-on techniques for corneal cross-linking (CXL). We then proceed to compare the two techniques, highlighting their similarities and differences. Additionally, we will discuss the partial full-thickness epithelium removal method, as well as the modified partial epithelial-off technique. © 2025 selection and editorial matter, Mehrdad Mohammadpour and Masoud Khorrami-Nejad; individual chapters, the contributors.