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Ocular pathologies

Keratoconus is a disease of the cornea, which progressively evolves. During this evolution the cornea adopts an irregular conical shape due to the alteration of the internal structure of the corneal tissue.

 

The main anatomical signs of keratoconus are thinning of the cornea in its central or paracentral zone, almost always accompanied by an elevation in this zone and a high irregular astigmatism, which necessarily causes poor vision.

 

In the early stages it is subclinical, i.e. it does not show symptoms and is only diagnosed with the practice of a topography with discarding programs such as Pentacam. It is very important to diagnose subclinical keratoconus, because it would contraindicate laser surgery for myopia, hyperopia or astigmatism.

 

Medical treatment

 

Initial treatment consists of the use of contact lenses to try to flatten the corneal cone, reduce astigmatism and improve vision. However, they are semi-rigid lenses, complicated to adapt and uncomfortable. They do not prevent the progression of keratoconus.

 

Surgical treatment

 
1. Crosslinking

What is Corneal Collagen Crosslinking? It is the process by which new bonds, or bridges, are generated between the existing corneal collagen chains, which is altered in keratoconus.

 

This process consists of saturating the tissue with a substance that sensitizes collagen, riboflavin.

The creation of these new bridges or bonds between the long collagen chains is then stimulated by the irradiation of a special light within the ultraviolet range, of a certain wavelength (UVA 375 nm), and which delivers a known energy at a certain distance (3mW/cm2), for a pre-established time (30 min).

 

What is the surgical procedure like? The procedure is performed with the patient lying down, lightly sedated and under local anesthesia. After anesthetizing the cornea with anesthetic drops, a small portion of the corneal epithelium is debrided so that the riboflavin can penetrate the corneal stroma.

 

The corneal tissue is irrigated with a riboflavin solution several times, until the saturation is verified and then the corneal tissue is irradiated with the necessary energy source to achieve the creation of these junctions.

 

Every 5 minutes it is irrigated with the riboflavin substance, without stopping the irradiation, reaching a total of 30 minutes of exposure to light.

 

The purpose is to increase the bond strength between the collagen chains, in a way that delays the evolution of keratoconus and thus avoids the increase of irregular astigmatism that this evolution produces. However, it does not change the pre-existing deformity.

 
2. Intrastromal ring implantation.

Intracorneal rings are arc-shaped pieces of pmma that are inserted into a corneal tunnel carved inside the cornea with Intralase laser. The procedure is performed under anesthesia with drops and lasts only a few minutes. Intracorneal rings reduce the irregularity and topographic decentration caused by keratoconus.

Do you have a damaged cornea? Contact us.

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