CORNEAL SERVICES BARBADOS:
A new division of Warrens Eye Care Centre:
Cross-linking (CXL) of the cornea is a new curative approach to increase the mechanical stability of corneal tissue. The aim of this treatment is to create additional chemical bonds inside the corneal stroma by means of a highly localized photopolymerization.
The indications for cross-linking are corneal ectatic disorders such as keratoconus and pellucid marginal degeneration, iatrogenic keratectasia after refractive lamellar surgery, and corneal melting that is not responding to conventional therapy
Corneal Services Barbados (CSB) is a new division of Warrens Eye Care Centre, specializing in corneal treatments and servicing Barbados and the wider Caribbean. We are pleased to announce the addition of a number of surgical services to the traditional corneal transplants (lamellar and penetrating) and amniotic membrane these new services include:
Corneal Collagen Cross-Linking
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Corneal cross-linking (CXL) is considered to be a safe procedure, provided the recommended safeguards are observed.
Minimum corneal thickness has to be 400 µ after removal of the epithelium. This is intended to protect the corneal endothelium from UV-A radiation. A 400 µ cornea soaked with riboflavin absorbs about 95% of the total radiation so that only a small amount reaches the endothelium.
Up until today, no sight-threatening side effects have been reported.
The procedure was developed fro 1993 by Prof. Theo Seller and Prof Eberhard Spoerl at the University of Dresden, Germany. First patients were treated in 1998. Today corneal cross-linking is performed in more than 300 centres around the world. Corneal Cross-Linking (CXL) has the potential to become the standard treatment for keratoconus thus preventing the need for penetration keratoplasty!
Today, more than 30,000 eyes have been cross-linked world wid in controlled clinical studies with a follow up of more than 5 years.
Clinical studies have shown a significant increase in best corrected visual acuity (BCVA) in more than 85% of the treated eyes.
Six months after corneal cross-linking (CXL) the refractive cylinder was reduced in over 80% of the eyes.
The steepest K-value was usually decreased by 1 diopter and the percentage of eyes that had clinically relevant reduction exceed 86%.
INCLUSION AND EXCLUSION CRITERIA
Keratoconus (KC) is the most common indication for CXL an unequivocal clinical and videokeratography diagnosis of keratoconus and its progression over the preceding six to 12 months are required for treatment selection.
The main exclusion criterion is a minimum corneal thickness of fewer than 400 microns. Other exclusion criteria noted in the literature include axial corneal scarring and corneal or ocular surface diseases.
There is no age limit on treatment. The lowest age of patients treated in published studies is 14.
MICRO-KERATOME ASSISTED KERATOPLASTY
In micro-keratome assisted keratoplasty, the partial thickness of the cornea is transplanted to selectively replace only the diseased portion, leaving the rest of the healthy cornea of the patient undisturbed. The lamellar surgery is less invasive when compared to penetrating keratoplasty but it requires finer surgical skill and instrumentation. In these procedures, the surgeon uses a microkeratome to cut the donor cornea, and often the recipient cornea, to the desired depth.
Unlike manual dissections, cuts with the micro-keratome create reproducible, smooth surfaces that facilitate good vision through the interface at the junction between the donor and the recipient corneal tissues.
Surgeons have described a number of lamellar techniques:
Descemets Stripping Automated Endothelial Keratoplasty (DSAEK) for Fuchs' and other endothelial dystrophies (i.e. posterior polymorphous dystrophy), post-cataract surgery edema (aphakic or pseudophakic bullous keratopathy) and some failed PK.
Superficial Anterior Lamellar Keratoplasty (SALK) indicated in the treatment of superficial corneal opacities resulting from previous refractive surgical procedures, infections, degenerations, dystrophiesk, superficial scars or trauma.
Deep Anterior Lamellar Keratoplasty (DALK) indicated when a thicker stromal lamella should be removed: keratoconus, post-herpetic scars, post-infectious opacities, some corneal dystrophies, and alkali or acid burn lesions.
Mushroom and Lap Joint Keratoplasty indicated in patients with full-thickness central stromal opacities but normal endothelium.