The cornea is a transparent structure that covers the front of the eye and allows light to enter it. Any alteration in that window which produces a spot or irregularity generates a bad image, which translates into bad vision.
Keratoconus is a rare eye condition in which the shape of the cornea is distorted. Its center becomes thinner and weakens slowly, taking the shape of a cone (fig 1), producing a patchy image on the retina and, therefore, blurred vision. Sometimes the cornea is so thin that it becomes inflamed and suddenly fills with water (called Hydrops) (fig 3). Wrinkles and scars can eventually form on the cornea, which results in the need of a cornea transplant.
Keratoconus Produces Bad Vision
There are two reasons for this:
- Due to distortion of the cornea. Looking through a deformed cornea is like taking pictures with a camera that’s lens has an irregular astigmatism (Fig 2).
- Due to inflammation or scarring of the cornea. Looking through an inflamed or scarred cornea is like taking pictures with a camera that has a dirty or opaque lens – the resulting picture or vision is blurred.
Symptoms and Causes of Keratoconus
Signs of Keratoconus usually start at puberty and progress over the next 10 to 20 years. The earliest symptoms include reduced vision and worsening of myopia. Sometimes Keratoconus is diagnosed with sudden inflammation.
Keratoconus occurs in 50 to 230 people per 100,000 and has been found in all races and both sexes, but most frequently affects women. It occurs more commonly in patients with Down Syndrome or congenital amaurosis (a rare form of blindness at birth). Very often the patient has a history of suffering from eye allergies and constantly rubbing their eyes.
The specific cause, however, is unknown. It is often very sporadic, which means that only one person out of an entire family could have Keratoconus – only seven percent of all cases are inherited. If one member of your family has Keratoconus, the chances that another blood related relative has the disease are less than 1 in 10.
Diagnosis and Treatment
Keratoconus is usually discovered when the patient seeks an ophthalmologist because of decreased vision. The diagnosis can be made only through eye exams by an ophthalmologist and is usually found when making a corneal topography.
Basically, it is important to start with rigid contact lenses because, due to their rigidity, they reform the cornea to its regular shape. Unfortunately, many patients can not tolerate the use of contact lenses because of allergies or simply because the cornea is so curved the contact lenses fall off. It is important to note that until a few years ago, patients who were diagnosed with these symptoms went directly for cornea transplant.
In the case of patients whose corneas are so stretched that they have white spots, corneal replacement is the only available course of action. However, patients who have no stains on their corneas can avoid transplant by using intracorneal rings.
Two methacrylate rings, in the shape of semicircles with a variable thickness as required by the patient, are placed inside the peripheral zone, away from the center of the eye to avoid the central visual field.
The insertion procedure is entirely ambulatory. Local anesthesia (in the form of drops) is used and the insertion usually takes only 10 to 15 minutes. The patient can begin working the next day, while using appropriate medications.
Once implanted, the rings flatten the central cornea and produce regulating effect. They remain motionless and invisible to the naked eye because they are as transparent as the corneal tissue in which they are placed. They help restore the cornea to its normal shape and also prevent the progression of Keratoconus. Many patients eventually find they no longer need their glasses, while others still use soft contact lenses or eyeglasses, according to their taste (Fig 4).
Methacrylate, the material which the rings consist of, is a very stable and highly biocompatible (does not generate any reaction in the eye) material. It is used in intraocular lenses for cataracts, which have proven to remain sturdy and clean throughout the patient’s life. The rings interact comfortably and naturally with the eye. If for some reason they must be removed, a specialized surgeon can easily reverse the procedure.
Intracorneal rings ~ An ophthalmologic Breakthrough
The creation of the intracorneal rings has been a breakthrough for ophthalmology. Cornea transplant surgeries are very delicate procedures that require high monitoring to avoid transplant rejection. By using the intracorneal rings, a properly selected patient can avoid the risks involved in transplantation and at the same time prevent the continued thinning of the cornea, all through a quick, simple procedure.
Benefits of Intracorneal Rings Surgery (Fig 5)
- It is a rapid method, as the procedure only lasts 15 minutes.
- Anesthesia is topical, with drops.
- You do not need to cover the eyes, so it’s recommended you get both eyes treated at the same time.
- The rings are transparent and concentrate the central optical zone of the cornea.
- They’re adjustable and can be exchanged for other rings of different thicknesses.
- Since the rings are added and there is no removal of tissue, it is a low-risk procedure.
- It is a reversible surgery, so if by any reason the rings must be removed, the patient’s vision will revert identically to how it was initially.
- It can be used to correct high myopia.
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- The procedure possesses a high success rate.
- It’s been used since 1990, in patients all around the world.
- It was approved by the Health Committee of the United States (FDA) in 1999.
- It has the EC mark for its use in Europe.
The use of this technique is simple, safe and ambulatory if the patient is properly selected by the cornea ophthalmologist surgeon.
Dr. Ilka De Obaldia Faruggia earned her Doctorate degree in Medicine at the University of Panama. To continue her studies, she moved to Mexico City to obtain the title of Doctor Specialist in Ophthalmology (UNAM). After that, she decided to participate and obtained a fellowship at the Hospital for Blindness Prevention, in Mexico, where she became certified as a Medical Subspecialist in Cornea, Refractive Surgery and External Eye Disease (UNAM).
Then, she finally concluded another Doctorate degree in Corneal Imaging (UNAM), while working as a Medical Instructor in High Specialty Eye Surgical Procedures in Latin America, as a teacher in different courses in United States, Argentina, England, Germany, Spain and Sweden. She is currently in charge of the Cornea Section of the Hospital Santo Tomas, organizing campaigns for cornea transplants, while leading her private practice in Panama City.
In the last three years, she began involving herself in the medical tourism environment and promoting this industry through local associations and civic clubs. In 2008, she co-founded Ageless Wonders Panama, where she acts as its Medical Director and, also maintains her Ophthalmology practice.
For more information on intracorneales rings for Keratoconus, please contact Dra.
Ilka De Obaldía F. MD. PHD, at Ageless Wonders Panama, Your Premium Wellness & Health Specialist, at ideobaldia@agelesswonders-pma.com. Panama: (507) 832-7289 and USA (786) 515-9596. www.agelesswonders-pma.com
