Penetrating keratoplasty

Before surgery   Operation process   Video   Recommendations after surgery    Complications    Benefits   Our advantages  Costs for femtolaser keratoplasty

Cornea is called a transparent hemisphere in front of the eyeball that covers pupil and iris. With its irregular shape, clouding, inflammation or a formation on the surface of the scar or tumor, the person inevitably begins to lose vision. Visible image gets distracted, distorted, glares and blurring appear.

When patient with pathology of the cornea visits an ophthalmologist they go through a compulsory examination, and then, as a rule, is prescribed conservative therapy that includes medication (eye drops and ointment), therapeutic treatments, and contact lenses. If these methods do not help and pathology continues to progress, surgery is the option. Required surgical intervention in this case is corneal transplantation - keratoplasty.

Keratoplasty - a surgical procedure that involves removal of the affected tissue of the cornea, and replacing it with healthy donor tissue. First successful keratoplasty was performed in 1905 by Edward Zirm.

Corneal transplantation can be penetrating and lamellar. When performing penetrating keratoplasty the whole stroma of the cornea is replaced with donor one. When performing lamellar keratoplasty only diseased tissue of the cornea is removed. Each of these methods has its own advantages and disadvantages, so the amount of interference, is always chosen by a surgeon-ophthalmologist, after analysis of the individual characteristics of the case.
The methodologies of this surgery and tools have been improved literally for decades. And today, of all performed transplantations in the world (heart, lungs, kidneys, etc.), corneal transplantation is the most common and most successful. Such successes are possible due to introduction of advanced technologies. For example, a femtosecond laser, this is literally the «last word» in surgical ophthalmology.
Femtosecond laser technology is developed in 90-ies of the last century. The name of laser is given to it due to very high speeds of the physical processes on which it is working. For example, 1 femtosecond is a quadrillion part (10-12) of a second. Today Femtosecond laser is called femtolaser, intralaser (from the name of the manufacturer IntraLase), femtosecond laser.

First use of femtosecond laser in ophthalmology was undertaken by a team of American scientists from the University of Michigan. At the moment, such lasers are used in laser vision correction, keratoplasty, implantation of intrastromal rings. Femtosecond laser beam contains of short pulses of light lasting just one billionth of a second, and having a magnitude of one thousandth of a millimeter. In this case, in the shortest time are sent millions of pulses. Their action is the formation of one to three micron bubbles in a given area of the cornea containing water and carbon dioxide. These bubbles very gently dissociate the tissue, forming a section with predetermined shape and size.

Before surgery

After decision on the implementation of the transplant, the ophthalmologist requests the donor material so that donor Bank prepares all the necessities to surgery date. If it is impossible to obtain the necessary donor material in the shortest possible time, the patient is added to the waiting list. Donor cornea, before transplantation, is carefully examined for various viruses (including AIDS and hepatitis); also it is tested for optical integrity and purity.

The patient preparing for surgery should undergo a general medical examination. When chronic or hereditary diseases, allergic reactions, or taking any medications, you should report this information to the attending ophthalmologist.

Process of the surgery

The operation is performed under local eye-drop or general anesthesia, depending on patient's age and his state of health. Important role in the selection of anesthesia plays a specific pathology of the eye. A patient does not see manipulations of the surgeon during the operation; his eyes are imposed with a special tool that fixes both eyelids. After examining an eye with electron microscope and making the necessary measurements, the ophthalmologist enters received data to the computer. All laser manipulations are computerized, which allows accurately calculating the amount of exposure and eliminating possible errors.

Unlike traditional operations performed with trephine - mechanical knife, femtolaser keratoplasty is performed with a laser beam. After laser cut, the diseased tissue is removed. Second phase of the operation is to prepare the donor cornea. Then the graft is sutured to the patient with subtle stitches, forming a "star pattern" around the outer edge of the cornea. Duration of the surgery, depending on the scope of the operation, is a little over forty minutes. Vision after keratoplasty is restored (improved) within the year.

Video

Recommendations after surgery

• The doctor will prescribe eye drop care that should be used according to the instructions;
• In first week after operation you should avoid pools, hot baths, do not use cosmetics for the eyes;
• You should not rub or put pressure on the eyes;
• The pain-killers prescribed by a doctor, should be applied only when necessary;
• You can continue regular daily activities, avoiding overexertion and physical stress;
• Getting behind the wheel of a car is possible only after prior consultation with your doctor;
• Doctor might prescribe a temporary wearing of special glasses or contact lenses;
• Be sure to visit the designated post-operative examinations, during which will be evaluated engraftment of the transplant and restoration of vision. According to the process of these examinations further treatment is corrected.

Complications

In 5-30% of cases is possible graft rejection. This percentage becomes higher when re-transplantation of the cornea is performed. Divested cornea becomes cloudy, vision is impaired. In the beginning, most of the processes of exclusion are easy to stop, when a timely treatment is initiated. Not to miss this point, the patient should remember signs, after noticing which you should immediately consult a doctor:

• pain,
• photophobia or photosensitivity,
• hyperemia,
• blurred vision.

Other complications that can occur, but are treatable, such as: infection, bleeding, swelling, glaucoma, retinal detachment. Also deformation of the transplanted cornea can cause astigmatism. Astigmatism often slows down the recovery of vision, but it is also correctable.

With a patient has related metabolic and endocrine diseases, the recovery time may increase. Some sensitivity to light after surgery occurs almost always. But this complication is temporary and goes away on its own after a few weeks.

Benefits

Femtolaser keratoplasty - corneal transplantation with the femtosecond laser has a lot of advantages. This fact contributes to the widespread of this technology worldwide. The following are especially important advantages of femtolaser keratoplasty:

1. When making operating incisions with a mechanical knife (trephine), often the cut is quite curved, which may be complicated by slow healing and scarring. Femtosecond laser more efficiently separates the corneal layer by performing a cut with sharp edges defined by the form, thickness and diameter. The cut is performed parallel to the surface of the cornea, which means that in the center it is the same thickness as that of the periphery. The deformation of the cornea is minimized.

2. The cut of the cornea by means of laser, is performed at ultra-high speeds, the duration of the impact pulse can be measured in fractions of a second, which gives the opportunity to separate the molecular bonds, without heating of tissues. The result is a minimization of tissue trauma, reduced pain after surgery, in comparison with the classical method.

3. The impact of laser is non-contact, therefore decreases the risk of infectious complications.

4. The recovery period after femtokeratoplasty is milder, unlike traditional interventions, rapid healing allows you in the earliest possible time to remove the stitches. The visual rehabilitation time is also reduced.

5. Laser keratoplasty is completely computerized, which eliminates random errors and allows to accurately calculate the volume of influence.

6. When using femtolaser in the stroma of the cornea are revealed less contaminations than when using a traditional trephine, because such manipulation is non-contact. Due to this there is less pronounced edema of the corneal stroma and rare formation in the cornea of connective tissue (scar).

7. The use of femto-technique ensures almost exact coincidence of the recipient bed and donor graft form, which greatly reduces the risk of postoperative astigmatism, in contrast to the classical keratoplasty, when the use of a metal trephine led to the development of high degrees of astigmatism in the postoperative period.

Our advantages

Before performing surgery, our patients undergo a thorough eye examination using the most modern diagnostic equipment from leading manufacturers. Our Clinic has all necessary equipment for corneal transplantation and a private Bank of bio transplantation. During 2014, in Moscow Eye Clinic were successfully performed 21 corneal transplantations, which is the highest indicator among non-state ophthalmology centers in Russia.

In Moscow Eye Clinic work specialists of world level. Penetrating keratoplasty is one of the priority activities of the clinic. The clinic has Professor Slonimsky Yuri Borisovitch - one of the most authoritative experts for treatment of patients with various pathologies of the cornea, a recognized leader in the field of penetrating corneal transplantation at keratoconus, the author of a monograph on keratoconus. Professor is a Board member of the Russian Society of Ophthalmologists. Among fellow ophthalmologists Yuri Slonimsky is a recognized authority in the treatment of patients with severe corneal pathologies. The same operations are carried out by a surgeon of the highest category, chief medical doctor of the Clinic Tsvetkov Sergei Alexandrovich, who has successfully performed more than 12 thousand surgeries of various complexity.

Individual approach and attentive attitude to every patient is the key to successful treatment in Moscow Eye Clinic. We care about our patients, so we are ready to provide all necessary help seven days a week, from 9:00am to 9:00pm. For the convenience of our patients we have a hospital (including day-hospital).

Prices for Cost of femtosecond keratoplasty

Price of the femtosecond keratoplasty is determined by the extent of the surgical interventions, the need to use general anesthesia, etc. The cost of penetrating keratoplasty in our clinic is from 70 000 rubles for one eye, at the reconstruction of the anterior segment of the eye cost of surgery may be increased. The biomaterial is charged separately (its cost is 75 000 rubles).

You can ask our experts any questions you have by phone in Moscow: 8 (800) 777-38 81 and (499) 322-36-36 (daily from 9:00am to 9:00pm) or online by using appropriate form on the website.