Khanna Vision Institute Keratoconus
:: Choosing between Intacs or Corneal xLinking
Crosslinking or Intacs : which is better for keratoconus?
Intacs changes the the shape of the cornea. Crosslinking strenghtens the cornea. Both are good options for treating keratoconus.
There are many options in the way to use to them.
1) intacs only
2) intacs followed by crosslinkage
3) cross linkage only
4) cross linkage followed by Intacs
5) intacs and cross linkage at the same time
We will look at these scearios of treatment of keratoconus by considering some real life examples. Each person and eye is unique and therfore when dealing with a corenal ectatic disease like keratoconus, the treatment startegy has to be customized to the stage of the Keratoconus disease. The factors to be taken into consideration would be the age, the thickness of the cornea both centrally and in periphery, the shape of the cornea, the steepest power of cornea, signs of progression. Keratoconus is a rapidly progressive disease of cornea which starts after puberty and may progress upto the 4th decade.
In youger people the disease is like wildfire. So it needs to be doused with crosslinkage, if you will. Later on the disease slows down but its stigma, drooping of cornea causes visual problems. At this stage the optical corrective effects of Intacs are more beneficial. Another popular alogrithm is to do intacs followed by crosslinkage. The rationale for way of treating keratoconus is as follows. The ectatic thin and weak cornea is elastic. That is why it becomes deformed. It will be easier for intacs to reform this weak cornea. Crosslinkage can than convert this elastic cornea to a plastic cornea which can resist internal eye pressure and is less likely to change shape. Very similar to a potter who works on clay while it is wet and sets the achieved design by firing it in the kiln.
Another group of surgeons are doing both procedures simultaneously. They feel it is easier for patients, especially those coming from far away places. They opine that intacs will change shape faster than cross linking can set in fixing the new shape and progresssively aiding the effect of intacs. For patients in twenties and thirties with visual distortion especially in bothe eyes, intacs can rehabilitate them. If there is any further progression in corneal protusion than cross linkage can be appplied. Otherwise they can be followed up, and that may be the only surgery they require. All these procedures are aimed at delaying the need of corneal transplantaion. The ideal goal is to never have to do corneal transplantation. Bothe the above mentioned are procedures of the 21st century and we feel they have broguht hope to people like lasik did for nearsighted people in the previous century.