The cornea is the transparent, tough, avascular front surface of the eye. It plays a pivotal role in providing clear vision with a smooth surface and uniform curvature. Its main role is optical, as it refracts light, allowing us to see crisply.
Keratoconus (conical cornea) is a progressive thinning disorder of the cornea. It will usually present in the teens or twenties. Keratoconus often progresses to make the cornea a more uneven conical shape over time. This induces irregular shortsightedness and astigmatism. If it is allowed to worsen over time, vision can be significantly impaired.
Treatments for keratoconus include glasses or contact lenses. Initially during the early phases, vision can be improved with glasses alone. Soft contact lenses may also help. Rigid gas permeable and sometimes scleral lenses can also be useful in more moderate to severe cases.
Surgical options in the management of keratoconus
1. Transepithelial Collagen Cross Linking with Oxygen Enhancement (Epithelium On)
Minimally invasive collagen cross linking.
The conventional procedure of Epithelium Off crosslinking (otherwise known as the “Dresden protocol”) involves removing the corneal epithelium prior to performing crosslinking. When compared to Epithelium On crosslinking, it is associated with several days of postoperative pain, a longer healing time, a greater risk of complications and a greater risk of corneal haze.
Dr. Kumar is privileged to be one of the few corneal specialists in Australia and the only corneal surgeon in NSW approved to provide Epithelium – On Cross Linking. This collagen cross linking procedure aims to strengthen the cornea and increase corneal rigidity. This provides biomechanical stability and attempts to prevent the progression of keratoconus.
This novel procedure provides numerous benefits. By keeping the epithelium intact, the procedure offers a more comfortable experience post operatively. During this procedure, the eye is exposed to riboflavin, high concentration Oxygen, and pulsed UV light.
The procedure is accessible either at Vision Clinic Sydney for our uninsured patients, or at Chatswood Private Hospital for our insured patients.
2. Femtosecond Laser Assisted Corneal Allogenic Intrastromal Ring Segment Implantation (Femto-CAIRS)
Minimally invasive cornea transplant.
Dr. Kumar is taking an industry leading step in the management of Keratoconus and other forms of corneal ectasia (Pellucid Marginal Degeneration and Post Laser Ectasia), by introducing corneal allogenic intrastromal ring segment implantation (Femto-CAIRS) to NSW.
This is a minimally invasive cornea transplant and is an additive procedure (donor cornea is added to existing cornea). The aim is to improve best-corrected vision. Patients still require glasses or contact lenses after surgery, although in some cases there is a significant improvement in uncorrected vision.
During this procedure a femtosecond laser is used to create channels inside the cornea. Specifically made sterile donor cornea tissue is then placed into the channel. This has the effect of improving corneal shape, effectively flattening the cornea where it is steep, and thickening where it is thin. This can improve overall quality of vision and especially night vision.
The recovery after surgery is rapid, although the full effect of the surgery may take three months to manifest. This procedure can be performed before or after collagen cross linking. Patients may notice improvements in vision soon after surgery.
3. Topography guided Phototherapeutic Keratectomy/Photorefractive Keratectomy (PTK/PRK)
The aim of PTK/PRK is to improve the corneal shape by remodeling corneal tissue. This procedure is a subtractive procedure (a small amount of corneal tissue is removed). This can be helpful to improve both uncorrected and best-corrected vision. The procedure can be combined with collagen cross linking or performed after collagen crosslinking.
4. Implantable Collamer Lens Insertion in Keratoconus
A collagen co-polymer lens (ICL) is placed inside the eye, to correct regular myopia and astigmatism. This can be useful in patients with keratoconus that obtain good vision with glasses. The aim is to reduce spectacle independence.
5. Deep Anterior Lamellar Keratoplasty (DALK)
Deep Anterior Lamellar Keratoplasty (DALK) is a specialised corneal transplantation surgery used to treat conditions like Keratoconus, stromal dystrophies, and corneal scars. Unlike traditional full-thickness corneal transplants, DALK preserves the inner layers of the cornea, making it a less invasive option with potentially fewer complications. Approximately 1,500 DALK surgeries are performed annually across Sydney and Australia, with 300 specifically for Keratoconus. Patients in Sydney can explore DALK as a treatment option at Vision Clinic Sydney, where trained surgeons offer this advanced procedure.
6. Penetrating Keratoplasty (PKP)
Penetrating keratoplasty (PKP) is a full-thickness corneal transplantation procedure used to treat conditions like keratoconus, corneal dystrophies, scarring, and complications from eye trauma or surgery. Annually, about 40,000 people undergo this surgery, which involves replacing the damaged cornea with a healthy donor cornea. Vision Clinic Sydney offers PKP for patients in need of this traditional surgical method. After surgery, patients may require glasses or contact lenses to correct their vision as the graft heals.
For more information on any of the above procedures, contact us or visit our website.
