question about i-brite procedure

Discussion in 'Ophthalmology: Eye Physicians & Surgeons' started by daphilster78, 09.18.12.

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  1. daphilster78

    daphilster78 Junior Member 7+ Year Member

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    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.
     
    Last edited: 09.18.12
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  3. Dusn

    Dusn 5+ Year Member

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    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.
     
  4. daphilster78

    daphilster78 Junior Member 7+ Year Member

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    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.
     
  5. MR1

    MR1 7+ Year Member

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    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.
     
  6. daphilster78

    daphilster78 Junior Member 7+ Year Member

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    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.
     
  7. bambi7

    bambi7 2+ Year Member

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

    sven Senior Member 7+ Year Member

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    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...
     
  9. hopefullyis

    hopefullyis

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    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!
     
    Last edited: 05.14.15
  10. LightBox

    LightBox 2+ Year Member

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    hopefullyis likes this.
  11. Iladelphia

    Iladelphia 7+ Year Member

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    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 likes this.
  12. DrZeke

    DrZeke yzarc gniog ylwolS 10+ Year Member

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    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.
     
    Last edited: 05.15.15
  13. aaron1950

    aaron1950

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    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?
     

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