CORNEAL COLLAGEN CROSS-LINKING (EPI-ON Vs EPI-OFF TECHNIQUE) [HD] HD

Cross-linking (CXL) with Epithelium-On or Epithelium-Off? There are two popular techniques for the CXL/C3R, Epithelium-On (not removing the epithelium which means keeping the epithelium intact) and Epithelium-Off (removing the epithelium). Epithelium is the membrane of tissues which covers the internal body organs. Here in this case it means corneal membrane. They are also popular by the short names as Epi-On and Epi-Off. In Epithelium-On, the corneal membrane (Epithelium) is not removed for the crosslinking surgical procedure while is case of Epithelium-Off it is removed before applying Riboflavin (Vitamin B2). Which technique is better, has been a controversial topic, as there are some advantages and disadvantages associated with each of them. So let’s here discuss the comparison between these two popular techniques- In Epithelium-On (Epi-On) procedure the Epithelium (corneal -membrane) is not removed and left intact. But in case of Epithelium-Off (Epi-Off) procedure the Epithelium is removed before the application of Riboflavin eye drops on the cornea. This makes the Epithelium-On less painful as compared to Epithelium-Off technique. Since epithelium is not removed in Epi-On, so it leads to faster healing and also reduces the chances of infection. Although the Epi-On may seem more attractive to many because of the above mentioned reasons but it has been found that Epithelium-On is less effective in comparison to Epithelium-Off. Epi-Off technique came into practice before the Epi-On, so Epi-Off has longer history and larger number of case studies as compared to Epi-On. Epi-On is recommended in cases when thickness of the cornea is not enough to perform standard Epi-Off procedure. But nowadays Epi-On is gaining popularity because of its many advantages like less painful, lower risks of infections, fast recovery etc. Since epithelium is not removed in Epi-On, so it leads to faster healing and also reduces the chances of infection. Although the Epi-On may seem more attractive to many because of the above mentioned reasons but it has been found that Epithelium-On is less effective in comparison to Epithelium-Off. Epi-Off technique came into practice before the Epi-On, so Epi-Off has longer history and larger number of case studies as compared to Epi-On. Epi-On is recommended in cases when thickness of the cornea is not enough to perform standard Epi-Off procedure. But nowadays Epi-On is gaining popularity because of its many advantages like less painful, lower risks of infections, fast recovery etc. As the number of patients treated with Epi-On is increasing with time, more case studies are available for research and to compare the outcomes and efficacy of these two procedures.