Latest Eye Surgery Technology
iLASIK: For the first time available in Cape Town, the bladeless iLASIK procedure. Now you can have your shortsightedness, farsightedness and astigmatism corrected without a blade ever touching your eye. NASA astronauts and US fighter pilots can have their laser vision correction surgery today because of the exclusive, validated safety and precision performance of the bladeless iLASIK technologies. Now you can have the exact same treatment at The Tygervalley Eye & Laser Centre.
Trans-Epithelial Corneal Cross-Linking with Ricrolin (without De-Epitheliazation)
Corneal collagen cross-linking is a surgical procedure that was developed to slow down or halt progressive corneal thinning, as occurs in keratoconus, pellucid marginal degeneration and refractive surgery-induced corneal ectasia. Studies in the late 1990’s demonstrated that collagen cross-linking augmented stromal rigidity by over 300% by increasing collagen fiber diameter and by inducing the formation of crosslinks in the collagen network.
Treatment entails exposure of the corneal stroma to ultraviolet A (UVA) light after saturating the corneal stroma with riboflavin. But since hydro soluble riboflavin is unable to cross the epithelial barrier, the cornea first needs to be de-epithelialized to a depth of at least 8mm in diameter for imbibtion of the stroma to be effective. The early post-operative period after conventional cross-linking treatment with riboflavin can therefore be painful, and visual rehabilitation usually takes 2 to 4 weeks.
With the use of the new trans-epithelial (TE) cross-linking with Ricrolin, the occurrence of a painful post-operative course and impaired vision during the first 2 to 4 weeks could be prevented. In addition, patients who don’t qualify for conventional cross-linking with riboflavin, because their corneas are less than 400 microns thick, can be treated with the use of trans-epithelial cross-linking and an eye drop solution Ricrolin. Ricrolin is composed of 0.1% riboflavin combined with enhancers which facilitate riboflavin penetration into the corneal stroma in an intact epithelium. A silicone corneal ring delivers the photosensitizing solution directly onto the intact cornea during the entire procedure.
The advantages of the new trans-epithelial cross-linking treatment with Ricrolin:
- Patients with thinner corneas can be treated.
- Pre-operative visual acuity is maintained.
- Patients under 10 years of age may be treated.
- No pain during the post-op period.
- You may return to school or work the day after treatment.
The latest eye surgery technology for cataracts
The revolutionary Crystalens
procedure will help you regain your vision better than
you ever hoped. The ultimate cataract treatment is called Crystalens, it
improves vision to a high definition extent that you will no longer require
glasses for excellent vision.
Until recently we have been using "White Star" technology for phaco-emulcification/cataract procedures, but we have now upgraded to the new "OZil Torsional" ultrasound system. The general consensus amongst leading cataract surgeons from around the world is that this, the latest in eye surgery technology, the OZil system, provides better post-operative vision and quicker recovery due to clearer corneas.
What is DSAEK?
DSAEK is the Descemet's Stripping Automated Endothelial Keratoplasty procedure. DSAEK is a new corneal eye treatment transplant technique where the unhealthy, diseased, posterior portion of a patient's cornea is removed and replaced with healthy donor tissue obtained from the eye bank. Unlike conventional corneal transplant surgery known as penetrating keratoplasty (PKP), the DSAEK procedure utilises a much smaller surgical incision and requires fewer corneal sutures. This usually results in more rapid visual rehabilitation for the DSAEK patient and also better post-operative visual acuity.
Who is a candidate?
DSAEK is indicated for those patients who have corneal pathology located on the posterior aspect of their cornea known as the endothelial layer. When endothelial cells are healthy, they function as a "pump-leak system" to provide nourishment for the cornea. In other words, these cells allow nourishing fluid from inside the eye (aqueous humor) to leak into the cornea. After the corneal cells have been nourished, the cells pump the fluid out of the cornea. If the endothelial pump is compromised for any reason the cornea will over hydrate and become cloudy. This most commonly occurs in patients who have sustained trauma to the endothelial layer during complicated cataract surgery or patients who have an inherited disease of the corneal endothelium known as Fuchs' Endothelial Dystrophy. Such patients are good candidates for the DSAEK procedure. It is also indicated for patients with endothelial rejection and Bullous keratopathy. This is indeed the latest in eye surgery developments.
DSAEK Corneal Transplantation Procedure
The first part of the DSAEK corneal transplant procedure involves removing unhealthy endothelial cells and attached Descemet’s membrane – the elastic layer found in the inner cornea. Once this has been done, the unhealthy tissue is replaced with healthy cells from a donor cornea. The entire procedure takes between 20 to 30 minutes to perform.
The patient is sedated approximately 30 minutes before the procedure, which can be performed under local or topical anaesthetic. The DSAEK procedure is performed under a special operating microscope as it is a microsurgical technique.
During the corneal graft, a femtoseond laser is used to cut both the donor and recipient cornea, as it is a very accurate and predictable way to cut corneas. In addition resultant astigmatism is much less and improved refractive outcomes are expected.
Once the procedure is complete, the small incision is closed with two or three sutures, which is less than with invasive keratoplasty procedures. The patient can then return home and return the next day for a follow up consultation on their corneal transplant.
Post-op visual recovery varies ddepending on the severity of the corneal cloudiness prior to surgery, but is much faster than with Penetrating Keratoplasty (PKP) procedures. Most patients notice improvement in their vision during the first two weeks after surgery with continued improvement during the next four to six weeks. This recovery represents a dramatic improvement over the time required following conventional corneal transplant surgery (PKP), which usually takes six to twelve months.
The Latest Eye Technology for Keratoconus
Cross-linking with riboflavin
Until recently there has been no eye treatment technology available for Keratoconus, and often patients ended up having to undergo corneal transplant surgery. A number of clinical studies have however demonstrated that progressive Keratoconus and iatrogenic ectasia can be stabilised by corneal cross-linking. UV radiation in combination with Riboflavin initiates molecular cross-linking of corneal collagen. Thus progressive corneal thinning is slowed down or even stopped and biomechanical strength of corneal tissue is improved. Although this treatment is not aimed at improving vision, it stabilises the cornea and prevents further deterioration in vision. After this eye treatment, many patients have improved vision with soft contact lenses and spectacles.
A topical anaesthetic will be instilled in the eye to be treated. Your corneal thickness will be measured to make sure that your cornea is thick enough for treatment. If it is too thin, it may be swollen with hypotonic solution, the surgeon will then remove the superficial epithelial cells of your cornea. Riboflavin drops will then be instilled onto the cornea at a rate of one drop every two minutes, for a period 30 minutes. After 30 minutes your corneal thickness will be checked again. Then the UV radiation treatment will be initiated, and we will continue to instil one drop of Riboflavin every two minutes for the duration of the treatment. After 30 minutes of radiation, the UV-X system then switches of automatically. A bandage contact lens will be placed on the eye for up to seven days, and you will receive eye drop medication to take for six weeks after treatment. During the healing process, your vision will be hazy and you may experience scratchiness, light sensitivity and fluctuating vision. Some patients will need to change their contact lens- or spectacle prescription after treatment, as there is often a progressive decrease in myopia and astigmatism following treatment. You will be seen at regular intervals to monitor this.
Optical Coherence Tomography
One of the latest eye technologies available, Optical Coherence Tomography (OCT) is a recently developed image-based diagnostic method that allows the analysis of the retinal structure by means of high-resolution topographic cross-sections of the retina. Whereas fluorescein angiography and indocyanine green angiography allow visualization of the chorioretinal vessels, OCT allows visualization of cross-sections of the retina, thereby enabling diagnosis and follow-up in many retinal conditions such as macular holes, vitreoretinal traction syndromes, macular edema, macular degeneration, diabetic retinopathy and glaucoma.
Because OCT uses a light beam, there is no need for contact with the eye. Scanned acquisitions can be completed in less than two seconds, and a retinal map can be generated within another few seconds. Dr. Johann Krüger states that it is a reliable and sensitive examination method and it makes it possible to quantify lesions and follow the progress of a disease.
Heidelburg Retinal Tomography (Optic nerve scan)
This is used to scan the optic nerve for early diagnosis of Glaucoma. It is also used to examine and monitor any changes of the optic nerve of Glaucoma patients.
Heidelburg Confoscan (Cornea scan)
The Heidelberg Confoscan is a confocal corneal microscope that allows the acquisition of two-dimensional images of the different corneal layers and of three-dimensional images of the cornea. It also enables the examiner to do a corneal endothelial cell count.
Photodynamic Therapy (PDT)
Photodynamic therapy (PDT) is a new treatment modality that may benefit some cases of wet Age-related Macular Degeneration (AMD). In wet AMD, conventional laser eye treatment is not possible due to the location of the choroidal neovascular membrane in the subfoveal space. The only option to preserve some central vision is a new treatment called Photodynamic Therapy. In this treatment a special dye (Visudyne) is injected intravenously. This preferentially collects in these abnormal blood vessels. The retina is then exposed to a non-thermal laser, which activates the dye. The activated dye then closes these abnormal blood vessels from the inside without any thermal damage to the retina. PDT reduces the risk of further vision loss, but cannot restore vision already lost. Early treatment leads to better outcomes. As part of the Photodynamic Therapy, a Kenacort intra-vitreal injection is given before, or directly after the procedure. This is to prevent retinal haemorrhaging during the PDT treatment. Better results are also expected with the use of the Kenacort injection because of its anti-inflammatory properties.
The latest eye technology is always within reach at our clinic.