What are the best treatments for keratoconus
Keratoconus and transepithelial crosslinking (Epi-on) treatment in our eye center
The Principle of a crosslinking treatment works like this:
Riboflavin (Vitamin B2) and UVA light together form a photo-oxidative compound. This is used in the crosslinking treatment because it is through this biochemical process in the corneal tissue new collagen compounds and thus Cross connections in the tissue arise. These lead to a Stabilization of the cornea and can thus another advancement of the caused by the keratoconus / keratotorus Avoid bulging.
Riboflavin serves as a photosensitizer and UV absorber, i.e. the riboflavin has to go to where the crosslinking should take place, namely into the stroma (a deeper layer of the cornea).
However, riboflavin molecules have difficulty penetrating the top layer of the cornea, the epithelium. That's why the original form of crosslinking the epi-off procedure. This means that the uppermost corneal layer has to be removed in order to enable penetration into the necessary layer depth. This is effective, but very painful for the patient and takes a long time to recover, as the top layer of the cornea first has to "grow back".
To that Crosslinking is gentler for the patient to do that became Epi-on procedure developed. That is much gentler because the Corneal surface not scraped off must become. In return, however, the treatment time is very long until the riboflavin has penetrated sufficiently deep into the tissue to be treated as a result of the radiation. Due to the very long exposure time, severe corneal irritation was possible.
No study has so far been able to demonstrate a decisive advantage of "conventional" crosslinking with scraping of the corneal surface. The results in the stabilization of the keratoconus are comparable and, in our experience, even superior due to the gentle procedure.
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