Sumaira Amir, Aamir Asrar, Muhammad Asif, Maha Asrar.
Comparative study of epi-off and epi-on Collagen Cross-Linkage in keratoconus patients.
Al-Shifa J Ophthalmol Jan ;12(2):88-96.

Purpose: To evaluateepi-off and epi-on(trans-epi) collagen cross-linkage procedures in keratoconus patients. Subjects and Methods: Eighty patients (102 eyes) with keratoconus were included in this prospective study from May 2014 to April 2015 in Amanat Eye Hospital,Rawalpindi.There were forty patients (51 eyes) with CXL epi-on procedure (Group I) and forty patients (51 eyes) with CXL epi-off procedure (Group II). Epi-off cxl procedure comprised isotonic riboflavin solution 0.1% with 20% dextran, whereas epi-on cxl procedure utilized hypotonic 0.25% riboflavin solution. The cornea was exposed to UVA 370 nm light for 3 minutes at an irradiance of 30mW/cm2. After cxl procedure patients were then followed up at baseline, 3 months and 12 months respectively. Results: In Group I, the mean age of patients was 21.83 years± 3.83 SD. There were 27 (67.5%) male and 13 (32.5%) female patients. The right eye was affected in 15 (37.5%) patients and left eye was affected in 14 (35%) patients. In Group II, the mean age of patients was 20.75years ± 4SD. There were 22 (55%) male and 18 (45%) female patients. The right eye was affected in 17 (42.5%) patients, left eye was affected in 12 (30%) patients.In both treatment groups there were insignificant difference in terms of improvement in best-corrected visual acuity and topographic parameters. Conclusion: This study showed that there were insignificant differences between both cxl procedures. The added advantage of patient comfort, reduced post-operative infection and early visual recovery gave epi-on cxl the best treatment of choice.

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