question about i-brite procedure

[daphilster78]

Hey Guys,

I'm asking for your advice, got an ophtho question (I'm a physician but in an unrelated field). So my right eye has always had a patch of large blood vessels and a small 'pinguecula' according to a couple opthalmologists I've seen, who basically told me to ignore the red appearance as its still 'healthy.' Nonetheless, it does bothers me and I've had some of my pts ask me if I have pink eye, esp since it can be bright red at the end of the day.

Anyhow I looked into options and found only one or two ophthalmologists with websites describing surgeries to reduce the appearance of prominent blood vessels. One guy is Dr Brian Boxer-Wachler who invented the i-brite procedure.

http://www.boxerwachler.com/whiteeyes/
http://www.youtube.com/watch?v=lfRmCIpBXBA&feature=related


My question is, how safe is this procedure? I know not many ophthalmologists do this. I had a consult with Dr Boxer-Wachler and he saws he removes the entire conjunctiva and then uses some mitomycin C for a few days. Is this safe? Is this a similar procedure as one would do for pterygium removal?

Thanks for any input.

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[Dusn]

Any ophthalmologists, and especially any anterior segment surgeon, should have the skill set needed to do this (because like you said it looks similar to pterygium removals); however, the vast majority believe that the risks for a cosmetic procedure like this outweigh the benefits. The risks with mitomycin c and removal of large areas of conjunctiva include limbal stem cell deficiency, corneal melt, scleral melt, recurrence or worsening of the same cosmetic problem, dry eye, vision loss... etc.

 

[daphilster78]

Thanks for the info Dusn. I'm leaning against this, but you pointed me toward important questions to ask: whether he's had any of the complications you mentioned. Overall, I notice one thing he advertises is that a "brand new" conjunctiva layer will regenerate over time. Is this true? And I wonder why he doesn't use amniotic membrane transplant like they do for pterygium surgery.

 

[MR1]

My opinion. Do not have the I-brite. That is a lot of conj removed. It does not grow back. The bare sclera epithelializes over. There are significant long term risks to that whether anyone will admit it.

If you want a ping removed go to a cornea surgeon and ask about local resection like we do with pterygium.

 

[daphilster78]

Thanks MR1, yes at this point it looks like there isn't enough info on long term outcomes. Also there aren't any peer reviewed publications of this procedure.

If I do go for a focal removal of a pinguecula, any recs on a good cornea surgeon in Los Angeles/OC area? I'll PM you.

 

[bambi7]

I have seen a couple of I-brite patients who have had terrible complications. Don't do it.

 

[sven]

Some of the prominent corneal specialists at my institution have extreme reservations about the i-brite procedure and contacted Dr. Boxer-Wachler seeking clarification on a number of points. He never responded. You'd be hard pressed to find anyone in the mainstream of opthalmology who would call the risk/benefit ratio acceptable. Simple, non-irritated pingueculae are usually slightly elevated and discolored. Vascularity can be prominent, but before considering surgery you might want to be sure that you don't have an irritated pinguiculum or 'pinguiculitis.' This condition often responds well to a short course of mild steroid drops (e.g. FML) and/or aggressive lubrication. Also, is it exacerbated by CL wear, etc.? After surgery you'd need a prolonged course of topical steroids anyway...

 

[hopefullyis]

It may be too late, but if OP hasn't made up their mind already, here is a recent case of bilateral scleral thinning after I-BRITE and a review of the literature on its associated complications:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356697/

Necrotizing scleritis? No thanks!

 

[LightBox]

http://www.ncbi.nlm.nih.gov/pubmed/25072832

These are all Wachler patients. I'm sure he doesn't go advertising this case series!

 

[Iladelphia]

Wait wait wait....

I just went to his website to try and figure out what the heck this procedure is all about. Everything is kind of vague. Sounds like he cuts off the bulbar conjunctiva, applies MMC, and then leaves bare sclera? On the videos it appears he gets pretty close to the caruncle - what's going on in there with the medial rectus exposure? That can't be good. Can you say diplopia?

This sounds like a horrible procedure - just by using basic ophthalmologic common sense and reading the scientific literature. Oh well, at least this procedure hasn't been advertised on some afternoon talk show like "The Dr.'s"....oh wait.....it has? How responsible

What does the Academy say about all this? I understand that the Academy can't really do anything about blue iris implants for brown eyes because this procedure is really only performed in another country. But this is being done by an ophthalmologist - in California no less?!? If the Red Hot Chilli Peppers taught us anything, it's that we as a country are extremely susceptible to a phenomenon known as "Californiacation"

Yikes!

 

[DrZeke]

Wait wait wait....

I just went to his website to try and figure out what the heck this procedure is all about. Everything is kind of vague. Sounds like he cuts off the bulbar conjunctiva, applies MMC, and then leaves bare sclera? On the videos it appears he gets pretty close to the caruncle - what's going on in there with the medial rectus exposure? That can't be good. Can you say diplopia?

This sounds like a horrible procedure - just by using basic ophthalmologic common sense and reading the scientific literature. Oh well, at least this procedure hasn't been advertised on some afternoon talk show like "The Dr.'s"....oh wait.....it has? How responsible

What does the Academy say about all this? I understand that the Academy can't really do anything about blue iris implants for brown eyes because this procedure is really only performed in another country. But this is being done by an ophthalmologist - in California no less?!? If the Red Hot Chilli Peppers taught us anything, it's that we as a country are extremely susceptible to a phenomenon known as "Californiacation"

Yikes!

There should always be a strong reason to use MMC... If it isn't justified then you should not use it. It's not without complications and we should all be wary of them.

 

[aaron1950]

Have a follow up question, say the procedure is done but regrets set in about having the procedure and the risks down the road is it possible to mitigate possible risks by addressing the removal of large areas of conjunctiva with auto grafting, I guess in a sense saying there are probably going to be trouble down the line let's go over all areas and minimize the risk?

 

[thefacts]

Hey Guys,

I'm asking for your advice, got an ophtho question (I'm a physician but in an unrelated field). So my right eye has always had a patch of large blood vessels and a small 'pinguecula' according to a couple opthalmologists I've seen, who basically told me to ignore the red appearance as its still 'healthy.' Nonetheless, it does bothers me and I've had some of my pts ask me if I have pink eye, esp since it can be bright red at the end of the day.

Anyhow I looked into options and found only one or two ophthalmologists with websites describing surgeries to reduce the appearance of prominent blood vessels. One guy is Dr Brian Boxer-Wachler who invented the i-brite procedure.

My question is, how safe is this procedure? I know not many ophthalmologists do this. I had a consult with Dr Boxer-Wachler and he saws he removes the entire conjunctiva and then uses some mitomycin C for a few days. Is this safe? Is this a similar procedure as one would do for pterygium removal?

Thanks for any input.

Please do not do the Dr. Boxer Wachler IBrite procedure. I had it done and three years later I have Sclera thinning and calcium deposits on both eyes. The whites of my eyes look gray do to the sclera thinning and the calcium deposits cause me constant pain. This Dr will play down the complications associated with this procedure and will tell you they are rare. They are not so rare. This Dr will tell you there is an easy fix to remove the calcium deposits but the fix is to scrape the calcium deposits away all the way down to the gray matter under the whites of your eyes. Then the Dr puts a white dye on to cover the gray but your sclera is not truly repaired. My eyes look much worse than before this procedure and I am in constant pain. I wish I had my old eyes back with the red blood vessels. My eyes were perfectly healthy before this procedure and now I feel like my life is ruined. Dr. Boxer says he does hundreds of these. This man knows that a certain percentage of people are guaranteed to have this complication, yet he is still willing to ruin the lives of unsuspecting people, for money. I wish I had someone who would have warned me. If I can save even one person the pain I have suffered, then maybe some good has come from this

 

[LightBox]

Please do not do the Dr. Boxer Wachler IBrite procedure. I had it done and three years later I have Sclera thinning and calcium deposits on both eyes. The whites of my eyes look gray do to the sclera thinning and the calcium deposits cause me constant pain. This Dr will play down the complications associated with this procedure and will tell you they are rare. They are not so rare. This Dr will tell you there is an easy fix to remove the calcium deposits but the fix is to scrape the calcium deposits away all the way down to the gray matter under the whites of your eyes. Then the Dr puts a white dye on to cover the gray but your sclera is not truly repaired. My eyes look much worse than before this procedure and I am in constant pain. I wish I had my old eyes back with the red blood vessels. My eyes were perfectly healthy before this procedure and now I feel like my life is ruined. Dr. Boxer says he does hundreds of these. This man knows that a certain percentage of people are guaranteed to have this complication, yet he is still willing to ruin the lives of unsuspecting people, for money. I wish I had someone who would have warned me. If I can save even one person the pain I have suffered, then maybe some good has come from this

I'm really surprised that people who have touted the benefits of this procedure have not been sued yet (hint, hint). I'm sorry if this offends anyone, but surgeons that do this procedure, while downplaying the severe consequences, are big db's. If you are considering I-Brite, read this first:

Delayed manifestation of bilateral scleral thinning after I-BRITE(®) procedure and review of literature for cosmetic eye-whitening procedures. - PubMed - NCBI

 

[Fascia Lata]

This is an awful procedure. I agree with all points mentioned. In addition, if, for example, you need sight-saving glaucoma filtering or tube shunt surgery in the future, you won't have the conjunctiva your glaucoma surgeon works with.

 

[Dusn]

It always amazes me how I see doctors who have done absolutely nothing wrong get sued all the time and then they are tried by a jury that has no medical knowledge. And yet there are these other doctors and clinics who are somehow able to commit blatant malpractice and are not even being secretive about it -- like the doctor performing this "Eye whitening procedure' or the nurse practitioners in the clinic in Florida who blinded 3 patients by injecting "stem cells" into their eyes. Our malpractice and medical regulatory system is completely bizarre.