Keratoconus is a corneal disease that creates a thinning of the tissue. As the tissue is thinned, normal pressure within the eye causes the tissue to slowly bulge forward into a cone-like shape. This steepening causes a decrease in the vision, which can continue to decrease as the cornea steepens. Keratoconus rarely results in total blindness, but most patients find daily activities become much more difficult to perform. The cause of keratoconus is still unknown, although there is evidence that supports a genetic origin, which can be exacerbated by environmental factors, such as allergies and eye rubbing. In most cases the changes begin in the teen years and eventually stabilize in their 30s or 40s.
Keratoconus is usually first treated with rigid contact lens wear. The lenses compensate for the corneal bulge and improve the patient’s vision. The lens needs to be properly fit to ensure the optimal vision, comfort and eye health. Improperly fit lenses can lead to other complications like scarring, infection, and corneal abrasion. If the patient becomes intolerant of the lenses for any number of reasons, INTACS provides an option prior to considering a corneal transplant.
What tests need to be done prior to INTACS insertion?
Topographies of the cornea including Orb Scan and OPD maps are required to ensure you are a good candidate for surgery. These maps show Dr. Weisenthal on which axis the steepening in the cornea is located, which helps determine where the INTACS inserts will be placed. You also need to have a refraction, concentrating on the cylinder and axis portions. A dilated eye exam is necessary within 3 months of surgery.
What happens during the surgery?
Prior to surgery you are given a number of drops, including anesthetic drops, to numb the surface of the eye. You are also given an oral sedative to help you remain relaxed during the procedure, which takes about 20 minutes. The eye is held open with a lid spring to prevent blinking. The corneal thickness is checked using a pachymeter, and then a small incision is made with a diamond blade on the axis where the INTACS will be placed. The incision is opened into ‘pockets’ which are then made into small ‘tunnels’. The INTACS are slid into these tunnels, and the incision is then closed with a suture.
How do the INTACS work?
The purpose of this surgery is to improve vision and allow patients to wear contact lenses or glasses. The implants reshape the tissue and add support to the thinning area, which prevents or decreases the bulging of the cornea, creating a more normal, uniform surface to fit with contacts or glasses.
What is the follow-up regimen?
The patients will be seen at 1 day to check vision and placement of the rings. The typical follow-up appointments are 1 day, 1 week, 1 month, 3 months and 6 months. The patient will be using Vigamox and Acular drops 4x per day for 2 days prior to surgery, postoperatively they will be using PredForte and Vigamox drops 4x per day for 1 week. They are informed not to rub the eye for 1 week after surgery, and are given goggles to wear while sleeping. They should not wear eye makeup for 1 week, and no swimming for 2 weeks after. The patients may experience vision fluctuation, foreign body sensation, and/or glare/halos at night, these things are all normal. It takes 3-6 months for the vision to stabilize after the procedure and for your final result to be obtained.
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