Rajesh Khanna, M.D.
Prior to any surgical procedure it is common to experience a degree of anticipation and anxiety. It may be comforting to know that the Intacs procedure is far less invasive than a corneal transplant or many other surgical procedures of the eye and the Intacs success rate is high. The surgeons performing the procedure are typically corneal surgeons, having expertise with keratoconus. Each surgeon has also undergone a rigorous training program specific to Intacs for treating patients with keratoconus.
Typically, Dr. Khanna will have you undergo a thorough eye examination. Your examination will include a variety of standard ophthalmic tests for this type of procedure, as well as general medical tests and a review of your specific medical history.
Anesthetic drops are used to numb the eye, which is held open throughout the procedure to prevent blinking.
Step 1: A single, small incision is made in the surface of the cornea.
Step 2: The eye is prepared for Intacs placement.
To stabilize your eye and ensure proper alignment of the Intacs inserts, the centering guide is placed on the surface of your eye. During this time, inner layers of the cornea are gently separated in a narrow circular area to allow for Intacs placement.
Step 3: The Intacs inserts are gently placed. After the second Intacs insert is placed, the small opening in the cornea is closed.
Step 4: The procedure is completed. The placement of Intacs inserts remodel and reinforce your cornea, eliminating some or all of the irregularities caused by keratoconus in order to provide you with improved vision.
Follow-up visits will be required to monitor the healing process and evaluate the visual benefits of the procedure. Even after a successful procedure, glasses or contacts still may be required to provide you with good vision. As with any surgical procedure, there are some risks, including infection. Some patients experience visual symptoms including difficulty with night vision, glare, halos, blurry and fluctuating vision.
A corneal transplant involves replacing a diseased or scarred cornea with a new one. When the cornea becomes cloudy, light cannot penetrate the eye to reach the light-sensitive retina. Poor vision or blindness may result. In corneal transplant surgery, the surgeon removes the central portion of the cloudy cornea and replaces it with a clear cornea, usually donated through an eye bank. A trephine, an instrument like a cookie cutter, is used to remove the cloudy cornea. The surgeon places the new cornea in the opening and sews it with a very fine thread. The thread stays in for months or even years until the eye heals properly (removing the thread is quite simple and can easily be done in an ophthalmologist's office). Following surgery, eye drops to help promote healing will be needed for several months.
Corneal transplants are very common in the United States; about 40,000 are performed each year. The chances of success of this operation have risen dramatically because of technological advances, such as less irritating sutures, or threads, which are often finer than a human hair; and the surgical microscope. Corneal transplantation has restored sight to many, who a generation ago would have been blinded permanently by corneal injury, infection, or inherited corneal disease or degeneration.
Even with a fairly high success rate, some problems can develop, such as rejection of the new cornea. Warning signs for rejection are decreased vision, increased redness of the eye, increased pain, and increased sensitivity to light. If any of these last for more than six hours, you should immediately call your ophthalmologist. Rejection can be successfully treated if medication is administered at the first sign of symptoms.
A study supported by the National Eye Institute (NEI) suggests that matching the blood type, but not tissue type, of the recipient with that of the cornea donor may improve the success rate of corneal transplants in people at high risk for graft failure. Approximately 20 percent of corneal transplant patients--between 6000-8000 a year--reject their donor corneas.
Phototherapeutic keratectomy (PTK) is one of the latest advances in eye care for the treatment of corneal dystrophies, corneal scars, and certain corneal infections. Only a short time ago, people with these disorders would most likely have needed a corneal transplant. By combining the precision of the excimer laser with the control of a computer, doctors can vaporize microscopically thin layers of diseased corneal tissue and etch away the surface irregularities associated with many corneal dystrophies and scars. Surrounding areas suffer relatively little trauma. New tissue can then grow over the now-smooth surface. Recovery from the procedure takes a matter of days, rather than months as with a transplant. The return of vision can occur rapidly, especially if the cause of the problem is confined to the top layer of the cornea. Studies have shown close to an 85 percent success rate in corneal repair using PTK for well-selected patients.
Another alternative, in cases with keratoconus, would be Intacs.
Learn more about how intacs work.
Click here for information on Comanagement of your Intac Surgery with your current eye doctor.
Learn more about new treatments for keratonconus.
If you are interested in keratoconus but are unsure which treatment is best for you, call or email to schedule your consultation with Dr. Khanna at the Khanna Institute today.