Epi-on or epi-off Cross-linking?

We are often asked which CXL treatment methods we prefer, most frequently on so-called “epi-on” or “transepithelial” cross-linking. We only do this in special cases. Our method of choice is still the classic “epi-off” cross-linking. 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, and of course you have to make sure that no infection occurs. However, with professional surgery, patient education and meticulous follow-up, these risks are extremely low. We have not seen a single case of post-CXL corneal infection in 10 years.

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Epi-Off Cross-Linking Procedure

Epi-on Cross-Linking: not yet 

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. After an initial euphoria, the “hype” about epi-on cross-linking has subsided. The reason is that the success rate, which is well over 90% for the classic “epi-off” CXL, falls to 60–70% for the epi-on procedure. Why?  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.

Ribovlavin

Oxygen

CXL

Ultraviolet

In a detailed study in our basic science labs, we were able to show that CXL can only work if there is enough oxygen.

Oxygen must penetrate into the cornea and this is prevented by the corneal epithelium. Accordingly, several clinical studies, including a Multi-center study under our guidance, showed that the efficacy of epi-on cross-linking is only 60-70%.

International leading cross-linking experts, including Prof. Hafezi from ELZA, commented on this in January 2018.

Our Choice

We find that the most effective method is also the best method for our patients, even if it means that the healing takes a little longer. What use is a “gentle” method, if it does not work?

Therefore, in most cases we do an “epi-off” cross-linking. An exception are cases where we fear that there could be infections after surgery due to poor patient co-operation, for example, severe eye rubbing after surgery. This mostly concerns small children and people with a developmental deficit. Here we apply an “epi-on” cross-linking. This is deliberately less effective because we have to avoid infections after surgery.

Prof. Farhad Hafezi was recently profiled in the Swiss newspaper, Limmattaler Zeitung, in which he discussed everything from his pioneering research into corneal cross-linking (CXL), how he has spent the last two decades improving CXL to better treat not just keratoconus, but infections of the cornea too – in a way that doesn’t require antibiotics or antifungal drugs to kill the infectious organisms.

The ELZA Institute

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Augeninstitut ELZA
4.7
Based on 90 reviews
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Squitieri Elias
Squitieri Elias
12:43 08 Sep 21
Die Behandlungen waren bei mir erfolgreich, alle waren sehr nett und haben mein Leben vereinfacht.Danke
Eliane Bossart
Eliane Bossart
13:01 05 Sep 21
Vor einem Jahr war ich einer ganz verzweifelten Situation und total im Stich gelassen. Meine Augen wurden aufgrund... eines ausgeprägten Kerakotonus immer schlechter, ich hatte Angst und war alleine mit meinen Problemen. Zudem vertrug ich die Kontaktlinsen nur noch ganz schlecht und hatte jeden Tag Schmerzen.Professor Hafezi hat mir mit zwei Operationen wieder das auf Grund der Situation mögliche an Lebensqualität zurückgebracht. Es war ein starpaziöses Jahr mit vielen Entbehrungen aber es hat sich gelohnt! Herzlichen Dank fuer die Unterstützung.read more
Gabriela Meyer
Gabriela Meyer
18:32 22 Aug 21
Ich wurde von meiner Optikerin auf Prof. Dr. Dr. Hafezi aufmerksam gemacht. Es war mir vorher nicht bewusst, dass meine... Augenkrankheit (Keratokonus) operativ mittels Cross Linking behandelt und so gestoppt werden kann. Die Beratung und Behandlung war sehr kompetent und ich fühlte mich jederzeit wohl. Die Operation verlief gut und das Ergebnis ist einwandfrei.read more
Naomi
Naomi
11:38 11 Aug 21
Ich bin sehr glücklich, dass ich das Elza Institute gefunden habe. Ich wurde von anderen Augenärzten abgewiesen, da... meine Augen zu kompliziert/schwierig zu behandeln waren. Prof. Dr. Dr. Hafezi konnte mir jedoch helfen und ich bin sehr glücklich und zufrieden mit dem Resultat. Vielen Dank!read more
Till B
Till B
08:30 19 Jul 21
Ich habe eine überaus kompetente Beratung und Behandlung erlebt. Die gesamte Betreuung war sehr freundlich und... professionell. Herzlichen Dank!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
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Augeninstitut ELZA
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