Other Cornea Procedures
The surface of the eye (also known as the cornea) may develop scar tissue, non-adherent cells or an irregular surface that can make the vision blurry, even with glasses, and at times may cause discomfort. When glasses, contact lenses and eye drops are not sufficient for vision or comfort, a surgical procedure may be helpful. Below are some of our commonly performed cornea procedures; some medically necessary and others elective.
Phototherapeutic Keratectomy (PTK) is a common laser procedure performed to smooth the surface of the cornea. This surgery is less invasive than a corneal transplant and the recovery process is not as extensive. Unfortunately, not everyone qualifies for the PTK procedure. Your doctor will discuss which option makes the most sense for you depending on your individual situation.
The PTK Procedure
PTK is performed using the excimer laser to smooth the scarred, irregular, or poorly adhering corneal surface to improve vision and/or to reduce discomfort. The treatment is done under a topical anesthetic and there is minimal discomfort during the procedure. The surface cells are brushed away, and a cool, non-penetrating laser smooths the surface of the cornea. A soft contact lens is placed on the eye as a bandage and will remain in your eye for approximately 5-7 days after the procedure. The entire treatment typically lasts less than 15 minutes. You might experience some pain after the surgery, however medicated drops or pills typically help minimize discomfort. Vision will fluctuate during the healing process, which can take as long as 3-6 months for some patients.
The primary goal of a PTK is to produce a smoother and clearer cornea. You may still need to wear your glasses to reach your best vision after the surgery. You will be instructed to use eye drops and oral medications following the procedure. An ointment is sometimes recommended for use at night to prevent corneal erosions during the healing period. If prescribed by your physician, you should begin using this medication the evening the contact lens is removed.
Intacs is an FDA-approved procedure for patients with low levels of myopia, or nearsightedness, and very little astigmatism. Intacs corneal implants are also an option for individuals experiencing intolerance to contact lenses who are facing a corneal transplant. This treatment may be the best option to stabilize the cornea, improve vision, and potentially defer the need for a corneal transplant. The Intacs procedure may also be used as an alternative treatment for LASIK and other types of laser eye surgery.
This procedure is often performed to improve vision and reduce the distortion caused by keratoconus. The implants are placed within the cornea to reshape and flatten the eye so that light rays can more effectively focus on the retina, increasing vision. For those battling Keratoconus, Intacs have the ability to flatten the steep part of the cornea, reducing the “bulging” or cone area of the eye, often leading to less visual distortions.
The Intacs procedure has a high success rate and offers a less invasive approach than a corneal transplant (and many other surgical eye procedures). The surgeons at Minnesota Eye Consultants who perform the procedure are corneal specialists who have expertise in treating keratoconus. Each surgeon has undergone a rigorous training program specific to Intacs for treating patients with keratoconus.
On the day of your procedure, anesthetic drops are used to numb your eye and keep you comfortable throughout the treatment. A single, small incision is made in the surface of the cornea and the eye is prepared for Intacs placement. To stabilize your eye and ensure proper alignment of the Intacs inserts, the centering guide is placed on the surface of your eye. During this time, inner layers of the cornea are gently separated in a narrow circular format to allow for Intacs placement. The Intacs are then inserted and placed, and the small opening in the cornea is closed. These inserts can be removed or exchanged and help maintain a more natural corneal shape to restore vision. The procedure takes about 15 minutes.
Follow-up visits will be required to monitor the healing process and evaluate the visual benefits of the procedure. Even after a successful procedure, glasses or contacts still may be required to provide you with good vision.
Conductive Keratoplasty (CK) uses very accurate pulses of radio-frequency waves to reshape the cornea and may be used for a variety of corneal issues. Some people use CK electively to correct mild hyperopia as a way to reduce their dependence on reading glasses.
Instead of a scalpel or a laser, CK releases radio-frequency energy through a probe as thin as a strand of human hair, without cutting or removing tissue. After application of a numbing drop, radio-frequency energy is applied to shrink small areas of corneal tissue. A circular shrinkage pattern can be used to create a band of constriction (like the tightening of a belt) in areas of the cornea that require tightening to help improve your vision. Your surgeon may offer CK alone or in conjunction with other treatments.
Individuals best suited for Astigmatic Keratotomy (AK) have minimal or moderate degrees of astigmatism, no major history of eye problems, have had a stable eye prescription for at least a year, and want better vision without the need for contacts or eyeglasses. With the high levels of success in correcting astigmatism with LASIK eye surgery, Astigmatic Keratotomy is now commonly performed alongside other procedures, most often cataract surgery. You may also hear Astigmatic Keratotomy referred to as “Corneal Relaxing Incisions”.
Simply put, Astigmatic Keratotomy are incisions placed strategically in the cornea with the goal of changing its curvature. The incisions flatten the steep portion of the cornea, making the eye more spherical. AK can be used as an enhancement following LASIK or PRK, cataract, or lens implant surgery. Most astigmatism, though, is still corrected with the excimer laser.
The cornea is the first part of the eye which focuses light. Pre-operative measurements of the corneal astigmatism provide very precise data which determines the ideal location for the incisions. After your eyes are numbed with anesthetic drops, incisions are precisely placed to change the curvature of the cornea, causing it to be more spherical in shape. Antibiotic drops are then applied to prevent infection.
Normal activities can usually be resumed in two days and although vision improvement varies, many patients can expect improvements between a day and two weeks. If vision improvement is not noticeable, it is not a sign that surgery has not worked but may take longer for specific cases and its best to speak with your eye doctor about the results.
In some patients who have refractive errors outside the range treatable with LASIK, or for those who have some cataract formation, a Natural Lens Replacement procedure may be an ideal option. This treatment involves removing the natural lens of your eye and replacing it with an intraocular lens (IOL) to help reduce the need for glasses or contact lenses. A Natural Lens Replacement procedure is very similar to cataract surgery, which is done to remove the cloudy natural lens. When the natural lens is removed, it needs to be replaced with a new intraolcular lens (IOL), and there are a variety of lens options available to best suit your visual lifestyle goals. Learn more here.
Patients who would benefit from a Phakic Intraocular Lens Implant (Phakic IOL) are those who have a strong glasses prescription, thin corneas or prefer a non-laser vision correction. The surgical technique is similar to that used in cataract surgery, however the natural lens is not removed, but an artificial implant is placed in front of it. The natural lens itself remains functional and intact.
Using topical or local anesthetic, the surgeon creates a small incision in the eye and inserts the lens using specialized instruments. The exact technique and placement of the implant will differ depending on the type of lens implant chosen. To learn more about the Phakic IOL treatment, visit our LASIK Alternatives page.