How the Keratoconus is robbing your eyesight?
The almighty GOD created this beautiful world which
is full of miracles. But what’s the use of this beauty without Eyes! So it’s crucial
to save our eyesight with good care and routine checkups.
Our cornea has tiny fibres of protein, called as corneal
collagen. These are the structural components of the cornea.
The main function
of corneal collagen is to keep the structure of cornea intact by acting as a framework. But when someone suffers from
keratoconus, the cornea becomes thin and starts to bulge outwards into conical
shape.
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Although there are many causes of keratoconus but the major culprit is Free –Radicals Damage. The free
radicals are harmful by-products that are produced in the metabolism process. These
free radicals are produced by our body tissues. In the same way, these harmful
free radicals are also generated by the corneal tissues too. We can consider
the collagen as a framework of steel beams. If some heavy enough objects are
bombarded over the steel frame, it will bend ultimately. Exactly analogous
phenomenon happens in the case of keratoconus.
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Here the free radicals bombard
itself over the corneal structure to make it weaker continuously. If the cornea
is healthy, it can easily defend itself from such harmful free radicals. But
the cornea of a keratoconic eye has weak self-defence system to fight with these
free radicals. This weakening is caused by the lack of antioxidants, as the
antioxidants have the power to trap the harmful free radicals.
So if not treated on time these free
radicals may continue to damage the corneal collagen and thus worsening the
vision. So the first thing is to stop the progression. A very popular technique
used to stop the progression of keratoconus is the Corneal Collagen Crosslinking.
It is also named as crosslinking, CXL, C3R, CCL and KXL. The crosslinking
technique has the potential to slow down or to stop the progression of
keratoconus. In very few cases it has also resulted in improved vision to some
extent. The reason behind this little improvement in vision due to Corneal
Collagen Crosslinking (CXL) is flattening of the cornea due to this technique. This flattening reduces the corneal cone and hence somewhat improved eyesight.
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What is Corneal Collagen Cross linking/Cross linking/C3R/CXL?
As I’ve
already mentioned that Corneal Collagen Cross-linking (CXL) is a surgical
procedure to slow-down or to halt the progression and to reverse the
keratoconus to some extent in rare cases due to flattening of cornea. Thus
cross linking has emerged as a wonderful technique to help keratoconus patients
all around the globe.
Now it is
possible to reduce the number of corneal transplants in most of the cases. If your
keratoconus is progressive in nature then you should not postpone the decision
to have C3R. Cross linking surgery procedure involves Riboflavin (Vitamin B2)
and UltraViolet-A (UV-A, 365 nm) light.
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This helps in strengthening of the
corneal structure with the formation of new bonds in collagen strands. It has
been found that C3R can strengthen the corneal structure by up to 300% and that is
good enough!!!
Procedure of Corneal Collagen Crosslinking (C3R/CXL)
Let’s now
discuss the procedure of Corneal Collagen Crosslinking in more detail...
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Image by: www.corneaclinic.com |
To perform
C3R anaesthetic eye drops also called as Topical Anaesthesia is used to make
the whole surgical procedure almost painless. So you will be awake during the
whole procedure!!!
You can see what the surgeon is doing with your eyes. Generally
single eye is treated at a time. Now riboflavin (Vitamin B2) eye drops are
applied and eyes are exposed to UltraViolet-A (UV-A, 365 nm) light for 30
minutes duration. So why Riboflavin and UV-A are used together? Because the
interaction of Riboflavin with UltraViolet-A is responsible for the formation
of extra bonds between the molecules of collagen. This leads to stiffening of
the cornea.
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After
finishing the treatment, the eye doctor applies antibiotic eye drops to prevent
any kind of infection after the surgery. Bandage Contact lenses could also be
used to prevent any injury to the eyes and for safety purpose. These contact
lenses need to be worn until the next follow-up visit to your eye doctor.
Cross-linking (CXL) with Epithelium-On or Epithelium-Off?
There are two
popular techniques for the CXL/C3R, Epithelium-On (not removing the epithelium which means keeping the epithelium
intact) and Epithelium-Off (removing the epithelium). Epithelium is the
membrane of tissues which covers the internal body organs. Here in this case it
means corneal membrane. They are also popular by the short names as Epi-On and
Epi-Off.
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In Epithelium-On, the corneal membrane
(Epithelium) is not removed for the crosslinking surgical procedure while is
case of Epithelium-Off it is removed before applying Riboflavin (Vitamin B2). Which technique
is better, has been a controversial topic, as there are some advantages and
disadvantages associated with each of them. So let’s here discuss the
comparison between these two popular techniques-
In Epithelium-On
(Epi-On) procedure the Epithelium (corneal -membrane) is not removed and left
intact. But in case of Epithelium-Off (Epi-Off) procedure the Epithelium is
removed before the application of Riboflavin eye drops on the cornea. This
makes the Epithelium-On less painful as compared to Epithelium-Off technique.
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Since epithelium is not removed in Epi-On, so it leads to faster healing and
also reduces the chances of infection.
Although the Epi-On may seem more attractive
to many because of the above mentioned reasons but it has been found that Epithelium-On
is less effective in comparison to Epithelium-Off. Epi-Off technique came into practice before
the Epi-On, so Epi-Off has longer history and larger number of case studies as
compared to Epi-On. Epi-On is recommended in cases when thickness of the cornea
is not enough to perform standard Epi-Off procedure. But nowadays Epi-On is
gaining popularity because of its many advantages like less painful, lower
risks of infections, fast recovery etc.
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As the number of patients treated with
Epi-On is increasing with time, more case studies are available for research
and to compare the outcomes and efficacy of these two procedures.
Is CXL safe? What are the complications and risks involved?
Although
Corneal Collagen Crosslinking (C3R/CXL) is very safe but still there may be
some complications. These complications may arise either during or after the
CXL procedure.
So before
discussing what these complications are...Let me tell you the underlying
causes behind these infections first.
These risks
and complications may be either short term or long term in nature. In CXL
complications may arise because of unsterilized (or not properly sterilized)
medical equipments used in the surgery or poor hygiene of the patient. These
may be the causes of infection.
Complications may also arise due to lack of
expertise of the surgeon or applying incorrect technique.
Here the
complications and risks of cross linking have been mentioned-
·
Infections
·
Temporary corneal
haze
·
Corneal edema
·
Endothelial
damage
·
Herpes
Simplex Virus reactivation
·
Ocular
surface disorders
·
Corneal
inflammatory infiltrates
·
Excessive
tearing
·
Defects in
epithelium
·
Photophobia
·
Painful eyes
·
Halos
· Treatment
failure etc.
Cost of Corneal Collagen Crosslinking
(CXL/C3R)
The cost may
vary as per the country. It may also be different in the same country too. The
Cross-linking (C3R/CXL) would Cost you around $2300-4000 for single eye. It is
better to ask your insurance company, how much it can help you financially.
What can you expect after C3R/CXL?
As discussed
already, the main purpose of crosslinking is to stop the progression of
keratoconus or to reduce the rate of its progression. So after CXL one can
expect the halting of the progression of keratoconus. You will be lucky if you
could get some improvement in your vision, as it is less probable.
Benefits/Advantages of Crosslinking
(CXL)
Following are
the impressive advantages of CXL procedure-
·
Halts the progression
of keratoconus/slows down the progression/improves vision in some cases
·
Reduces the
chances of cornea transplant to great extent by stabilising the cornea
·
Strengthens the
cornea
·
Painless
surgical procedure
·
No incision required
like other surgical procedures
·
Low risks
involved
·
Easy
procedure
·
Can be used
with INTACS for better vision
·
Fast recovery
Care after Corneal Cross-linking/precautions
As mentioned above, there are two types of
techniques that are adopted for the corneal cross-linking. These are CXL with
epithelium On (Epi-On) and CXL with epithelium off (Epi-Off). Epithelium is the
corneal membrane that protects our eyes from infections. Since in Epi-Off
procedure, epithelium is removed, so the chances of infections are high. The removal
of epithelium makes it more painful and uncomfortable to the patients. So it is
important to take precautions to keep your eyes free from any kind of
infection. You should be very careful in following the prescriptions by your
eye doctor. Any carelessness may lead to complications after surgery. Doctor
may prescribe you some medicines/eye drops to reduce the pain and make you more
comfortable. It is better to understand the level of discomfort and pain that
can be expected after the eye surgery. The chances of infections are reduced
after the formation of epithelium. It is advised to visit your doctor for
follow-ups as instructed.
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Very informative on keratocononus.
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