Epi-on or epi-off Cross-linking?

Call us Now

+41 44 741 8181

Call Back

Request Here

Make Appointment

Come to us @ ELZA

Email Us

info@elza-institute.com

Recommend Us

Thank you!

Telemedicine

Online consultation

We are often asked which CXL treatment methods we prefer, most frequently the question is whether we perform “epi-on” or “epi-off” (Dresden protocol) cross-linking.

As technology has advanced, our answer has evolved from “epi-off” in most cases, to “epi-on” in most cases. Here’s why.

Epi-off Cross-Linking

The first step of classical cross-linking requires the removal of the outermost layer of the cornea, the corneal epithelium, so that riboflavin (vitamin B₂) can penetrate the cornea correctly. The success rate of this “epi(thelium)-off” protocol is extremely high, well over 90%. A relative disadvantage is that the cornea has to heal again. In the first few days there are inconveniences such as a burning and biting sensation in the eyes. Of course you also have to make sure that no infection occurs. However, with professional surgery, patient education and meticulous follow-up, this risk is extremely low. We have not seen a single case of post-CXL corneal infection in 10 years.

Play Video

Epi-on procedures in the past just didn’t work well enough. This has changed.
This is why we have not only adopted epi-on, but are actively developing it too.

Epi-on Cross-Linking

The idea of epi-on cross-linking came up because it does have theoretical advantages: less postoperative burning sensation of the eyes and a reduced risk of infection. The reason why ELZA did not adopt epi-on CXL in the past was that the epi-on success rate was around 60–70% – well below the 90% success rate of epi-off CXL. In 2013, our research group discovered that in addition to vitamin B₂ and UV light, the presence of oxygen is another essential factor for successful cross-linking. However, using this knowledge, ELZA’s surgeons and researchers worked to develop better formulations of riboflavin that penetrate the epithelium, and smarter cross-linking UV irradiation protocols that have helped deliver epi-on CXL success rates that approach those of traditional epi-off CXL protocols.

Our choice: epi-on

We reserve epi-off CXL for only the most aggressive cases of corneal ectasias where the absolute maximum cross-linking effect is necessary. For all other cases, the reduced pain and risk of post-operative infection are in our view, acceptable trade-offs for a marginal difference in cross-linking efficacy.

 

  • Awards, Podium Power, Uncategorized
ELZA’s Nan-Ji Lu wins VSY Ophthalmology Rising Star 2023 Award
The VSY Biotechnology Ophthalmology Star Awards (OSA) for 2023 were announced at the Satellite Symposium during the ESCRS conference in Vienna. The awards recognize contributions to the field of ophthalmology, specifically research and clinical studies that have advanced understanding and treatment of eye diseases. This year, Dr. Nan-ji Lu from the ELZA Institute in Zurich received the third-place award for her clinical study titled “A New Keratoconus Staging System Based on OCT.” Dr. Lu’s research focuses on a new system for staging keratoconus, a condition affecting the cornea, and has implications for its diagnosis and treatment.
  • by Prof. Farhad Hafezi
  • September 15, 2023
Read More
  • Emilio Torres, Farhad Hafezi, Lamis Baydoun, Nanji Lu, Nikki Hafezi, Podium Power
ELZA at ESCRS 2023: Vienna
Join us at #ESCRS2023 in Vienna! ELZA’s top surgeons & researchers will present the latest in ophthalmic treatments. Dive deep into innovation with us! 🌟👁️ #ELZA at #ESCRS
  • by Prof. Farhad Hafezi
  • August 28, 2023
Read More
123Next

Rate Us

Newsletter

Stay informed & get the newsletter

ELZA Jobs

Observership
Fellowship
General opthalmologist
Non-clinical staff

For Patients

Make An Appointment Financing Laser Surgery New to ELZA?

Media

ELZA News Archive Video Interviews Awards
  • ELZA Institute AG ©
  • 2023

The ELZA Institute

EN | DE | PT
.
.
Augeninstitut ELZA
Augeninstitut ELZA
4.8
Based on 109 reviews
powered by Google
review us on
mike
mike
09:02 04 Jan 23
Overall as a 50 year old, who wanted to continue to avoid wearing glasses and/or contact lenses, my goal was 100%... achieved with ELZA and Dr. Hafezi. I greatly appreciated the overall approach by Dr. Hafezi and his friendly and competent team in reviewing my vision at the start and following a comprehensive eye exam- the explanations of my options. For me I chose PRK in one eye for a monovision solution to correct short sightedness which was becoming more prevalent in night driving and sports such as skiing and cycling. PRK heals slowly but the outcome is worth the wait- and the cost- you use your eyes every waking moment- and for me I cannot see any reason not to pursue better vision with the ELZA team! A great quality of life enhancement!read more
Zuzana Fecko
Zuzana Fecko
21:48 31 Oct 22
Thank you so much, Dr. Torres and prof. Hafezi. 26 years I was only “dreaming” about the eye surgery due to possible... complications. I was worried ..Thank you for encouraging me to make a decision and thank you for your professionalism, explanations and great work!I wish you all the best, lots of success and only happy patients!read more
Serena Fazio
Serena Fazio
11:15 06 Mar 22
I have been to the ELZA clinic to have surgery for my miopy, as my eyes were rejecting the contacts and I was tired of... wearing glasses. From the first preliminary visit, to the actual surgery and post-surgery care Dr. Hafezi and all his collaborators have been extremely professional, considerate and helpful. All the steps of the (very short!) surgery were thoroughly explained to me in order to be as calm as possible, together with the medication plan and precautions to be aware of so that my eyes could heal in the best way possible. By following their exact instructions, the healing process has been very successful and smooth, and after about one week I was able to see perfectly. I absolutely recommend this team and their expertise!read more
Robin A
Robin A
11:43 16 Feb 22
Top experts and professional team. Highly recommended
Thunder Shiviah
Thunder Shiviah
14:05 23 Nov 21
After some research on local options I decided to go with ELZA since it stood out as the best. The operation and the... post-operation recovery went extremely smooth (something I was worried about with PRK). Now my vision is much better than I had hoped and I have no side effects such as dry eye or night vision problems. Thank you!read more
Thomas S.
Thomas S.
09:37 07 Jul 21
My left eye had to be operated on because of a cataract. As I had an Artiflex lens implanted a few years ago, it had to... be removed first before a modern lens could be implanted to correct the cataract. Prof. Hafezi treated me in an very competent and friendly manner. I am very happy with the result.read more
Selma A. Rahim
Selma A. Rahim
19:45 02 Jul 21
Dr. Hafezi.. the KING OF CXL🤴
Gianluca Ricci
Gianluca Ricci
12:46 10 Apr 21
Great team and service!
rehaneyecare
rehaneyecare
05:36 08 Apr 21
Excellent surgeon
Steven H.A
Steven H.A
16:13 11 Jan 21
Prof. F. Hafezi s expertise is enormous and he has a very pleasant and calm nature which gives the patient... security.Thank youread more
Online Commande
Online Commande
09:19 05 Dec 20
Totally creepy, very arrogant Prof.He just want your money.It may explain, why this Prof. is not in the center of the... city of Zürich and why he has been thrown away from University of Geneva.read more
Elena Churilova
Elena Churilova
10:06 17 Nov 20
At the moment, 3 months have passed since the moment I made laser vision correction in this clinic. and I can say that... I am happy that I chose this particular clinic and Prof. F. Hafezi. The entire staff of the clinic is very friendly, treats patients with sympathy and patience if they are nervous before surgery (my big gratitude to Aida Alili for all support and patience). The doctor Hafezi and other doctors of the clinic are very professional and ready to explain to you as many times as you need. I can only recommend!read more
Michele Aggiato
Michele Aggiato
18:17 10 Jan 20
The day I had Prof Hafezi checking my keratoconus I knew I was finally in the right place after years of searching for... a good ophthalmologist. Prof Hafezi recommended a surgery due to a drastic degeneration of my cornea. The surgery was performed by himself with the assistance of Dr Rodriguez, one more collaborator of Prof Hafezi’s team who got my full trust.read more
Ashley Faulkes
Ashley Faulkes
15:30 21 Mar 16
Professor Hafezi and the team at the ELZA Institute have done an amazing job of creating a first class eye clinic, with... cutting edge technology and support. I went there for a dry eye issue and other issues with my prescription, and they were easily able to help me and put me on the road to better vision! High recommend them to anyone in the Zurich/Aargau area.read more
Next Reviews
js_loader
Write a review
Augeninstitut ELZA
Augeninstitut ELZA
4.8
Based on 109 reviews
powered by Google
review us on
js_loader