CXL+ Laser Surface Regularisation(CXL Extra)
Cross-linking(CXL) for keratoconus and Post-LASIK ectasia was gained European Certification in year 2007. Our patients show 100% slowing of progression following CXL. Although this is very good, CXL alone leaves the patient with their poor pre-procedure vision which is mostly disappointing for keratoconus and post LASIK-ectasia patients. The poor vision following CXL has necessitated the development of new combination procedures to improve vision at the same time of halting/stopping keratoconus progression with cross-linking. One such exciting procedure is CXL-Extra, where CXL is combined with limited topography guided Laser application to regularise and reduce the corneal cone, higher order abberations and astigmatism found in keratoconus. This combination gives much superior corrected vision following CXL. Night vision driving problems can be eliminted with this procedure. This is how the majority of patients are being treated in the leading centres around the world, and at SAFESIGHT. The aim of the procedure is not to rid you of glasses, but to give you much improved vision without or without your glasses or contact lenses.
Corneal ring segment inserts.
A recent surgical alternative to corneal transplant is the insertion of intrastromal corneal ring segments. A small incision is made in the periphery of the cornea and two thin arcs of polymethyl methacrylate are slid between the layers of the stroma on either side of the pupil before the incision is closed. The segments push out against the curvature of the cornea, flattening the peak of the cone and returning it to a more natural shape. The procedure, carried out on an outpatient basis under local anesthetic, offers the benefit of being reversible and even potentially exchangeable as it involves no removal of eye tissue.
The principal intrastromal ring available is known by the trade name Intacs. Internationally, Ferrara rings are also available. Intacs are a patented technology and are placed outside the optical zone, whereas the smaller prismatic Ferrara rings are placed just inside the 5 mm optical zone. Intacs are the only corneal implants to have gone through the FDA Phase I, II and III clinical trials and were first approved by the Food and Drug Administration (FDA) in the United States in 1999 for myopia; this was extended to the treatment of keratoconus in July 2004.
Clinical studies on the effectiveness of intrastromal rings on keratoconus are in their early stages, and results have so far been generally encouraging, though they have yet to enter into wide acceptance with the refractive surgery community. In common with penetrating keratoplasty, the requirement for some vision correction in the form of spectacles or hydrophilic contact lenses may remain subsequent to the operation. Potential complications of intrastromal rings include accidental penetration through to the anterior chamber when forming the channel, postoperative infection of the cornea, and migration or extrusion of the segments. The rings offer a good chance of vision improvement even in otherwise hard-to-manage eyes, but results are not guaranteed and in a few cases may worsen.
Early studies on intrastromal corneal rings involved use of two segments to cause global flattening of the cornea. A later study reported better results could be obtained for those cones located more to the periphery of the cornea by using a single Intacs segment. This leads to preferential flattening of the cone below, but also to steepening the over-flat upper part of the cornea.
Most patients still need scleral lens fitting to normalize their vision following Intacs. This to normalize your vision. scleral lenses can be fitted for you at SAFESIGHT.
DO YOU WANT MORE THAN JUST CROSS-LINKING? DO YOU WANT TO IMPROVE YOUR VISION AT THE TIME OF CROSS-LINKING? CALL US ON 011 346 5025/ 0815455385 MONDAY – FRIDAY 8AM- 5:00PM. Safesight Cataract and Eye Laser Centre, Waverley, Johannesburg.