Non Laser Surgery
Keratoconus (KC) is a progressive, noninflammatory, bilateral (but usually asymmetrical) ectatic corneal disease, characterized by paraxial stromal thinning and weakening that leads to corneal surface distortion.
Visual loss occurs primarily from irregular astigmatism and myopia, and secondarily from corneal scarring.
Typically commences at puberty and progresses to the mid thirties at which time progression slows and often stops.
Between age 12 and 35 it can arrest or progress at any time and there is now way to predict how fast it will progress or if it will progress at all.
In general young patients with advanced disease are more likely to progress to the point where they may ultimately require some form of surgical intervention. Management.
Subclinical Keratoconus(KC) normally causes no visual impairment, the patient may require glasses or nothing to achieve 20/20 vision.
Clinical Keratoconus is classified in several stages according to the conus severity.
The initial stages can be anticipated with contact lenses while the more advanced stages may need implantation of intracorneal rings,or laser combined with corneal cross linking.
The final stage can be treated only with Keratoplasty(cornea transplantation) .
A non-invasive treatment CXL (corneal collagen cross-linking riboflavin) treatment has been proven to strengthen the weak corneal structure in Keratoconus.This method works by increasing collagen cross-linking, which are the natural "anchors" within the cornea.
These anchors are responsible for preventing the cornea from bulging out and becoming steep and irregular (which is the cause of Keratoconus).
During the 30-minute, in-office treatment, custom-made riboflavin eyedrops are applied to the cornea, which are then activated by a special light. This is the process that has been shown in laboratory and clinical studies to increase the amount of collagen cross-linking in the cornea and strengthen the cornea.
In published studies, such treatments were proven safe and effective in patients.
There are different types of Phakic IOLs(intra ocular lenses) all of them aiming to correct high Myopias and Hyperopias especially in cases where the lasers are not able to offer a safe solution.
Under topical anesthesia and through a small peripheral corneal incision the lens is inserted in to the eye and is positioned in front of the eye’s natural lens.
The results usually are impressive; the patients gain high quality and acuity vision after the first pot op day.
It is a simple procedure for an experienced surgeon not lasting more than 30 minutes and on the other hand is safe and painless for the patient.
The most important step of the procedure is the preop evaluation and the selection of the proper patients.
The complications are very low 1-2% and are mostly related to the type of the lens and to the surgeon skillfulness.The major advantage of the method comparing to laser is that it is reversible and can correct Myopias up 23 dpt.
In normal eyes the transparent lens is located behind the iris,its functional purpose is to focus the emerged light from the surrounding space on the retina (fig. 1). The progressive cloudiness of the normal transparent lens is called Cataract (fig. 2). It starts as a whitish spot and in time ends up in a solid white lens named Mature Cataract.
The initial symptoms are: blurred images, halos around lights and poor colour discrimination, which after some years leads in complete loss of vision. The more frequent cause of Cataract is the ageing of human organism. In rare cases Cataract may present at birth (Congenital Cataract), after long-lasting reception of medication, after eye injuries and as consequence of chronic eye and systematic diseases.
The only effective way of treatment is the surgical removal of Cataract and the implantation of a synthetic lens at the same place, where it was located the blurred lens. Today with the modern surgical methods that are in practise (phacoemulsification), the Cataract can be removed successfully at the initial stages, long before maturation. The success rate of the surgery is very high and the re-establishment of vision approaches the physiological levels.
The applied method of anaesthesia is called "Topical anaesthesia with drops" and it is the most modern method of anaesthesia in Cataract surgery.
It is completely painless, because the anaesthetic is administered in form of drops and no in painful injections.
The results are impressive, the patient may see few hours after surgery without any bruises or swelling in the eyelids.
The cataract is removed with a special instrument of ultrasounds and the utilised technique is named Phacoemulsification.
From a small incision of 3.0 mm, the Cataract is emulsified and aspirated through a small needle tip that is inserted inside the eye.(fig. 3)
In the continuity without enlarging the incision, a special foldable lens is implanted inside the eye.
The small incision is left without sutures and heals in most cases in two weeks.
The intraocular lens remains in the eye forever.(fig. 4)
The advantages of the method are: very short time of hospitalisation and quick recovery of vision, enabling the patient to regain his or her daily activities very soon.