Download Keratoconus Surgery and Cross-linking by Roberto Pinelli, Antonio Leccisotti PDF

By Roberto Pinelli, Antonio Leccisotti

A workforce of exceptional surgeons from world wide who've made fresh significant advances within the administration and therapy of Keratoconus, have shared their worthy stories during this publication. every one of them is a superb scientific author in addition; the standard which isn't in general discovered. comprises most recent strategies which have been expressly ideated to reinforce or to interchange a weakened corneal stroma. Collagen cross-linking might end up to be very powerful within the administration of Ectasia.

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Additional resources for Keratoconus Surgery and Cross-linking

Example text

IntacsTM treatments were first instituted by Colin in 1997 on patients with keratoconus who had a central clear cornea but were contact lens intolerant. The aim of this treatment is to modify the shape of the cornea to improve vision rather than arresting the condition. These forms of treatment may be of particular interest in those patients where more invasive forms of management are more at risk such as in highly atopic individuals and in Down syndrome patients. The treatment consists of inserting semicircular plastic rings within the peripheral corneal stroma in order to shorten the arc length of the anterior cornea and therefore force the anterior cornea to flatten.

In the eye, ascorbic acid absorbs UV radiation (at cornea, lens and vitreous body areas); it is a cofactor of several enzymes, the best known of which are prolyne hydroxylase, enzymes involved in byosinthesis of collagen. In vitreous body, after cataract surgery (absence of glutathione), ascorbic acid (in ascorbate form) absorbs UV not stopped by the lens, resulting in the formation of free radicals, disaggregation of hyaluronic acid and increase in cross-linking of collagen fiber networks. Riboflavin-UVA Treatment A photo sensitizer is a substance which is activated by the absorption of light at a given wavelight and which can induce free radical reactions in its activate form.

The basic mechanism of the photochemical treatment of keratoconus is to use Riboflavin as a photo sensitizer and apply on it UV irradiation at a determined wavelength to induce free radicals reactions and increase in this way the cross-links in the collagen fibers. Riboflavin has a high UV absorption between 360 and 450 nm; due to its additional shielding all structures behind the corneal stroma, including corneal endothelium, anterior chamber, iris, lens and retina, are exposed to a residual UV radiant exposure less than 1 J/cm2 (in accordance with safety guidelines).

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