Keratoconus Treatment: Cross-linking, INTACS

IMPROVED FUNCTIONAL VISION WITH OR WITHOUT GLASSES AND CONTACT LENSES

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HOW KERATOCONUS TREATMENT WORKS

In this video, Prof Mohammed Muhtaseb explains what you need to know about keratoconus treatment

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KERATOCONUS TREATMENT EXPLAINED

In these toggles we explain what you need to know about keratoconus treatment

INTACS or intracorneal rings, are clear, thin prescription inserts placed in the periphery of the cornea during a brief procedure.

INTACS inserts can treat:

  • Keratoconus
  • Pellucid marginal degeneration
  • Corneal ectasia

INTACS inserts are a great solution if you are intolerant to contact lenses and if your only other option may previously have been a corneal transplant.

INTACS SK

INTACS SK corneal inserts are used to treat severe keratoconus, achieving a greater effect than regular INTACS in these advanced cases.

INTACS inserts reshape the curvature of the cornea from within, without removing any corneal tissue. You cannot feel them, and they are no more visible than a contact lens.

Imagine your cornea as a tent with a curved top. If you push out the sides of the tent, the top flattens. Similarly, when INTACS inserts are placed in the sides of the cornea, they flatten the central cornea and so reshape the cornea towards a more natural curvature.

INTACS inserts change the curvature of your eye by adding ultra-thin ring segments. They can be removed entirely if necessary, returning your eyes to their preoperative condition.

Adding volume in the periphery of the cornea causes a flattening effect to reduce the curve of the cornea more centrally. This reduces the degree of myopia and astigmatism, so improving the level of vision that can be achieved without glasses or contact lenses.

Furthermore, by reducing the corneal curvature, INTACS increase the likelihood of being able to fit and tolerate contact lenses. It may even be possible to use soft contact lenses to achieve the best visual results.

If you have keratoconus but are contact lens intolerant, the goal of the INTACS procedure is to improve functional vision with contact lenses or glasses and in some cases without them.

INTACS SK

The main difference is that the SK version is placed slightly closer to the centre of the cornea, with a diameter of 6mm. This gives a greater flattening effect on the cornea.

After the procedure

After the procedure, there may be a single small stitch in the cornea. If so, we will remove this after a few weeks.

We will give you drops to use after the procedure.

These will be:

  • Antibiotic / anti-inflammatory drops for four weeks
  • Lubricating artificial tear drops to use as required

We will arrange follow-up examinations and monitor you carefully after your procedure.

The INTACS procedure does not prevent you from having a corneal transplant in the future if this is required. However, INTACS may ultimately be found to delay or prevent the need for a corneal transplant, by helping to keep the cornea nearer to its natural shape.

If your keratoconus requires a combination treatment of INTACS followed by corneal collagen cross-linking (CXL), we will usually wait for 1 – 3 months after the INTACS before we proceed to perform CXL.

INTACS treatment may sometimes not provide the desired outcome; the INTACS segments may extrude and need to be removed; the cornea may attract growth of blood vessels and the segments may need to be removed; and sometimes there can be thinning of the cornea over the INTACS segments.

The main alternative to INTACS is to continue with glasses or contact lenses as the main route to visual rehabilitation. If these have been unsuccessful they are likely to remain so as time passes by.

INTACS have a high success rate for treating contact lens intolerance and allowing patients to wear contact lenses more comfortably.

The success rate reduces the more advanced the keratoconus, so it is not possible to provide an overall success rate as a % since every case will be different and should be assessed individually.

When can I get new glasses/contact lenses?

The shape of the cornea will typically take three months (or longer) to stabilise, and during this time your vision will fluctuate. Only once the cornea has become stable should you consider glasses or contact lenses for definitive correction of any residual refractive error.

Some people choose to seek temporary glasses or contact lenses during the recovery period. There is no objection to this, but the prescription may change until the cornea becomes stable.

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ABOUT THE EXPERT

Prof Mohammed Muhtaseb, FRCOphth

Consultant Cornea, Cataract and Refractive Surgeon

iLase is the private practice of Consultant Ophthalmic Surgeon, Prof Mohammed Muhtaseb. Based in South Wales, he is one of the very few ophthalmologists working in the UK who is a fellowship-trained specialist in Cornea, Cataract and Refractive Surgery. He holds full specialist registration with the General Medical Council and was appointed as a Consultant in the NHS in 2006.

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