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Feb 16

2015

Intacs And Corneal Collagen Cross-linking, Two New But Effective Procedures

Keratoconus Intacs is a single day procedure performed in the OPD section. Eyes are numbed by putting anesthetic drops, and lid holder is applied to the eye to prevent blinking. Surgeon creates a thin channel within the cornea to insert Intacs with the help of high-speed Femtosecond Laser beam. Then, one or two Intacs, are inserted as per requirement. Individual shape of the cornea decides the requirement of one or more intacs. Surgeons insert intacs into the outermost edge of the cornea keeping the center portion untouched.

As the procedure ends, surgeon places a contact lens bandage, puts drops on the eyes and uses a plastic shield to keep the eye safe.  A small suture may be placed if needed. Patient can go home in the evening or next day morning. Antibiotic eye drops are prescribed to avoid infection.

Intacs are made from a contact lens-like material, and the shape is like two small crescents. Insertion of intacs makes the cornea flat, and it reduces the irregular astigmatism and asymmetries of cornea caused by Keratoconus.  In a few cases, intacs can be removed safely, and cornea can return to the preoperative condition.  The technique is extremely useful in improving contact lens fitting. It also avoids transplant of the cornea and improves fitting and comfort of contact lens. Surgeons have found it useful for cross- linking of corneal collagen and vision improvement as well. The procedure also corrects without glasses or contact lenses.

Insertion of intacs is done using a Laser beam by using a special intra-corneal tunneling instrument. The laser is known as Intralase. There are multiple selection techniques available for it, and surgeons use an appropriate one depending on the particular situation. A suction ring is placed to stabilize the eye.

Post-operative care

Vision improvement happens immediately after the procedure, but there may be fluctuations initially. Patients can resume work within one or two days with a few restrictions. Doctors look at the improvement during the follow-up period and perform additional procedures if required. It can be changing size and position of intacs, adding supplementary procedures like Conductive Keratoscopy or  CK. Patients must remember that intacs are not a onetime procedure. There can be other enhancements to optimize the outcome.

Results can vary depending on individual response. Cornea improves in a majority of cases, but there can be a need of contact lenses or spectacles. Glare or haloes around illuminated objects during the night is another optical side-effect.  In rare cases, there are secondary problems like insertion of intacs or infection during corneal healing. Surgeons take the decision of removing intacs in some extreme cases. All these complications are discussed with patients before surgery. Doctors analyze the requirement beforehand and assess the risk involved as well.

Intacs and CK- the combined surgery

Eye specialists are always in search of innovative procedures for treating eye problems. It has been observed that in a few cases, it is possible to combine Conductive Keratoplasty with Intacs procedure. It can be performed in a single session or back-to-back depending on the situation. It is a revolutionary approach to correct Keratoconus. Since CK is a procedure of correcting the shape of the cornea by shrinking the collagen, it allows excellent reshaping of a keratoconus cornea when combined with Intacs procedure. It can be done along with Intacs or when the sutures get removed.

Of course, it is not a recognized procedure by FDA and the clinic has to take approval for it. Since CK is not an approved procedure for correcting Keratoconus (though it is approved for correcting farsightedness), patients have to select it as an offline procedure. The patient and doctor can discuss it and go ahead for it with a mutual consent. Doctors check whether the patient is a good candidate for Intacs-CK combined surgery or not.

In a few cases, Intacs may act as a supplementary procedure for correcting severe nearsightedness through LASIK or LASEK/PRK procedures.  Especially, cases where the cornea is exceptionally thin it is not possible to achieve significant results by laser treatments only. So far, clinical trials have shown quite satisfactory and enthusiastic results.

Corneal Collagen Cross-linking procedure or CXL

CXL is a relatively new and experimental procedure performed in a few countries of Europe. It is still under observation and research is being done to assess its effectiveness and safety in correcting problems like Keratoconus or Corneal Ectasia after LASIK surgery. It is a procedure performed with the primary goal of strengthening and stiffening the corneal fibers so that progression of Keratoconus can be prevented. It also decreases the cone steepness in some cases. Though the safety and effectiveness are still points of research, initial results show that it is quite effective.

The procedure

Surgeons put anesthesia drops to prevent pain and discomfort. A lid retainer is installed to prevent blinking. The surgical procedure starts with removing of surface epithelial cells of the cornea. Riboflavin drops put for 30 minutes so that cross-linking effect gets enhanced and the rest of the eye from exposure to Ultraviolet exposure. Patients are told to look at a source of UV light (365 microns of wavelength and 3mW/cm2 power) for half an hour. A soft contact lens bandage is applied. Anti-inflammatory drops and antibiotic drugs are prescribed for two weeks. Contact lenses are placed for a week so that the healing process can be improved.

Conclusion

Intacs procedure is one of the prominent and important procedures for correcting Keratoconus. It is equally effective in making the eyes tolerant of contact lenses. It avoids the possibility of corneal transplant up to a large extent. Improving vision correction with glasses or contact lenses is other applications. Success of the procedure varies on case-to-case basis. Some patients achieve a fantastic correction while some need additional corrections. Simplicity and relatively shorter healing time make it a suitable procedure for a majority of patients. Many specialty hospitals and eye treatment centers offer it, but it is very important to check the proficiency and expertise of the doctors.