ELZA’s role in Corneal treatments

Members of ELZA have been instrumental in improving current technology used to reshape the human cornea. We are also heavily involved in research on this topic and teach numerous times throughout the year in Europe, Asia, Africa, and the Americas.


The Chapters

Pterygium
Low vision after transplantation
Low vision due to corneal scars
Cornea and thyroid hormone
Cornea and Pregnancy
Terrien marginal degeneration

Posts on Cornea published by ELZA


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Pterygium – a sunlight-related disease

Pterygium

A pterygium is a degenerative disorder of the conjunctiva. It is directly related to the extent of ultraviolet (UV) irradiation that an eye has seen throughout life. So people that were exposed to lots of sun, or to sun at high altitude, tend to develop a pterygium much more often than others that grew up in countries with less sun exposure.

A pterygium can lead to dry eye, redness, and reduced vision.




Surgical removal

A pterygium can be removed surgically. In a first step, the pterygium is excised under the operating microscope, and the conjunctiva is closed, either directly, or using a conjunctival transplant. A pterygium may have a very high recurrence rate, because even microscopically small portions may lead to regrowth. Therefore, in a second step, the area of excision on the cornea is treated using the excimer laser. This treatment also smoothens the corneal surface and improves the regularity of the surface..

If the pterygium is successfully treated, dryness and redness as well as reduced visual acuity will resolve over time.


Sunglasses – protect your eyes prom pterygium and early cataract



Low vision after corneal transplantation


One main goal of a corneal transplantation is to avoid rejection of the transplant. Nowadays, potent immunosuppressive agents and other medications help minimize the risk of rejection.

The other main goal is to achieve a satisfactory visual acuity. Although perfectly accepted by the host, the transplant often shows a major amount of irregular astigmatism, which cannot be corrected by glasses or contact lenses. Here, customized Femto-LASIK or PRK procedures may help to increase the regularity of the surface, and increase spectacle-corrected visual acuity. These are highly customised surgeries, and should not be confounded with cosmetic procedures (“living without glasses”).


A 34 year-old-patient presented with a clear transplant, but an irregular astigmatism of over 11 diopters, and a visual acuity of 10%.

A Femto-LASIK procedure was performed by an ELZA member, combined with a re-lift after 6 months to correct for the astigmatism in a two-step approach. The final result was highly satisfactory.



Low Vision due to Corneal Scars


Corneal Scars often is a result of bacterial/fungal/viral infection or of trauma. Depending on its location, the scar may greatly reduce visual acuity, due to opacification of the cornea irregular astigmatism.

A number of customized approaches may eliminate the scar, inclusing PTK, wavefront-guided PRK and Femto-LASIK, or lamellar keratoplasty.



Cornea and thyroid hormone


Hypothyroidism (underfunction of the thyroid)  has a major infleunce on the biomechanical stability of the cornea. The exact mechanism of action has not been elöucidated yet, but it involves thyroid receptors in the human cornea. Under certain circumstances, underfunction of the thyroid may influence the clinical outvome of keratoconus, and may also represent a risk when performing refractive laser surgery.


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Cornea and pregnancy


Recent research findings have shown that pregnancy may have a major impact on the cornea. The increase of estrogen levels in the blood and tissues of a pregnant woman has a direct impact on the biomechanical integrity of the cornea. In other words, the cornea becomes loose at the end of pregnancy. This may have a number of conseuqnces.

Keratoconus: Pregnancy may worsen an existing keratoconus.

Ectasia after LASIK: Our group has published on cases of female patients who showed good vision with excellent and stable results after LASIK surgery for years, until they became pregnant. During pregnancy, they developed postoperative ectasia, a condition similar to keratoconus, and a major copmplication after refractive laser surgery. In some cases, the delay between LASIK surgery and occurrence of ectasia was nine years. These cases show that the surgeon’s experience in judging the cornea preoperatively, is of utmost importance. Also, the surgeon must have adetaiuled knowledge on all the factors that may influence corneal biomechanics.


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Terrien Marginal Degeneration (TMD)


Terrien marginal degeneration (TMD) is a rare, bilateral, progressive corneal melting disease usually occurring in middle to late age.

It may lead to progressive corneal thinning, and even corneal perforation. The management of TMD remains a major challenge, and even corneal transplantation is difficult and often fails. Members of ELZA published on the first successful partial reversal of a TMD using cross-linking technology. Please find more information in our posts below.


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