CORNEAL CROSS-LINKING
Kornea rahatsızlıkları arasında en önemlilerden birisi olan keratokonus, kornea şişkinliği de dahil olmak üzere korneanın ilerleyici bir şekilde incelmesine veya bozulmasına neden olur.
Korneanın incelmesi ve bozulmaya başlaması, görüşünüzü olumsuz anlamda etkilemeye başlayan koni şeklinde bir çıkıntıya neden olur. Keratokonus semptomları şiddetlenirse kornea nakline ihtiyaç duyulur. Bununla birlikte çoğu keratokonus vakası kornea nakline gerek duymadan başarıyla iyileştirilebilir.
KERATOCONUS TREATMENT WHAT IS CORNEAL CROSS LINKING?
Keratoconus and corneal ectasia are degenerative conditions in which the collagen in the cornea weakens and begins to stretch and thin outwards. Weakening and thinning of the cornea occurs as a result of the collagen bonds in the cornea breaking or stretching. Weakened collagen changes the shape of the cornea and affects how light enters the eye. This may result in blurred vision.
Corneal Cross Linking, which treats and stops the progression of keratoconus, is a method that has been frequently used for the last 5 years. Cross Linking is a procedure that uses a combination of riboflavin eye drops (a type of B vitamin) and ultraviolet (UV) light to prevent further weakening of the cornea. The aim of this treatment is to strengthen the collagen bonds of the cornea. Cross Linking treatment does not reverse blurred or distorted vision that has already occurred, but works to prevent vision from gradually getting worse.
Before Cross Linking treatment, the patient will need a complete eye examination to determine the severity of keratoconus or corneal ectasia. Based on the examination, the doctor will decide whether a cross-linking procedure is a suitable treatment option. Some tests need to be performed before CCL treatment. These examinations can be listed as follows:
•Measuring vision level both with and without glasses
•Drop and non-drop refractive error (refraction)
•Thickness of the cornea
•Corneal topography
• Fundus examination
HOW IS CROSS LINKING TREATMENT APPLIED?
Cross Linking tedavisinin uygulanabilmesi için öncelikle hastalığın ilerleyici olup olmadığının tespit edilmesi gerekmektedir. Yapılan tetkikler sonucunda hastalığın ilerleyici olduğu tanısı konulursa daha sonra Corneal Cross Linking yani CCL tedavisi uygulanabilmektedir. Peki bu tedavi yöntemi nasıl uygulanır?
•Riboflavin/ B2 vitamini damlatma
•Öncelikle topikal anestezi yapılmakta ve damla ile göz uyuşturulmaktadır.
•Daha sonra topikal anestezik damla damlatıldıktan sonra spatül veya alkol yardımıyla korneanın epiteli mekanik olarak kaldırılmaktadır.
•Bu işlem sonrasında ise riboflavin yani B2 vitamini, kornea üzerine 5 dakika ara ile 2’şer damla damlatılır. Bu 30 dakikalık bir işlemdir.
UV Işığı Uygulaması:
30 dakikalık işlem sonrasında hasta biomikroskopa oturtulmaktadır.
Daha sonra ön kamarada riboflavin floresansı görülür ve ışık 4-5 cm uzaklıktan yaklaşık 7 milimetrelik bir alanda 30 dakika boyunca uygulanır.
Bu işlem sırasında her 5 dakikada bir göze 2’şer damla riboflavin damlatılmaktadır.
•En son, göze bandaj takılır ama göz kapatılmaz.
•Bu işlemler sonrasında göz 3 gün sonra tamamen iyileşmektedir. Bu 3 günlük sürede hasta ağrı, batma ve yanma hissedebilir. Tedavi sonrasında damlalar 1 ay süreyle kullanılmaktadır.
CROSS LINKING TYPES
İki türü vardır: epi-off ve deneysel epi-on. (“Epi”, korneanın dış tabakası olan epitelin kısaltmasıdır.)
Epi-off tekniği, doktorunuzun damlaları yerleştirmeden önce epiteli çıkardığı anlamına gelir.
Epi-on ile doktorunuz, göz damlalarını koymadan önce göz damlası veya sünger ile epitelinizi gevşetir.
AFTER CORNEAL CROSS LINKING SURGERY
After Corneal Cross Linking treatment, pain in the eyes and head may be felt for approximately 3 days. However, as the effect of anesthesia wears off, burning and stinging occurs. Immediately after surgery, severe pain, redness, swelling of the eyelids and blurred vision may be experienced for approximately 5-6 hours. These are perfectly normal effects. To deal with such situations, you need to rest in dim light as soon as you get home. In addition, you can take painkillers and apply cold to the eyes with the eyes closed. On the 1st and 3rd day of the surgery, a check is made and the protective lens is removed. In this way, stinging and blurred vision will improve slightly. After Corneal Cross Linking treatment, keratoconus will no longer progress, meaning the cornea will not become thinner day by day. During the healing process, the eye may feel like itching; the eye should not be rubbed or scratched during this period.
SIDE EFFECTS OF CROSS LINKING SURGERY
As with most surgeries, corneal cross-linking can sometimes cause problems such as:
•Eye infection
•Eye pain or swelling
Damage to the cornea or epithelium
Blurred vision, hazy vision or other vision problems
Before the operation, ask your doctor about your chances of experiencing these problems.
FREQUENTLY ASKED QUESTIONS ABOUT CROSS LINKING SURGERY
Am I awake during Cross Linking?
Patients are usually awake during treatment. This feature works very well for patients. Many patients listen to music, podcasts, audio books, etc. during the procedure. listens and there is no pain.
How long does the operation take?
Cross Linking process takes 75-90 minutes. It would be beneficial to arrange in advance the use of a vehicle and a companion to accompany you after the surgery.
Is pain felt during the Cross Linking operation?
Cross Linking is a painless procedure as anesthetic drops are instilled before the operation and at intervals throughout the procedure. The operation is very comfortable for the patients. However, after the procedure, patients may complain of burning, stinging, watering and pain until epithelial healing is completed.
Will I need to remove my contact lenses before the procedure?
Yes. Your doctor will probably stop wearing hard contact lenses for a few weeks before surgery and may ask you not to wear them again for about 1 month after treatment.
To whom is Cross Linking not applicable?
Cross Linking cannot be applied to patients with advanced stage keratoconus who have spots or cracks in the cornea and whose cornea is very thin. Therefore, early diagnosis and early intervention are extremely important.
Are there any treatments combined with Cross Linking?
In recent years, PRK / No Touch Laser can be combined with Cross Linking in suitable patients. This combination can be preferred in keratoconus patients who are diagnosed early and have good corneal thickness. The purpose of this combination is, on the one hand, to stop the disease by performing Cross Linking on the cornea, and on the other hand, to cause an increase in the patient's uncorrected visual acuity by making a slight correction in the refraction of the eye with PRK or No-Touch Laser.
What will change after Corneal Cross Linking operation?
You will enter the healing process with Corneal Cross Linking (CCL) treatment. Blurred vision will occur for 7 to 10 days after the treatment. In the first month, you may sometimes see clearly and sometimes blurry. Corneal cross-linking treatment strengthens the tissues of the cornea. In the following periods, the quality of vision will become clearer. It is necessary to go for a doctor's check-up approximately 3 months after the surgery. In addition, you should definitely follow the treatment methods your doctor plans for you for 6 months.
WHEN CAN I RETURN TO NORMAL LIFE AFTER SURGERY?
You can return to your normal life from the 3rd day after the surgery. Of course, this is a situation related to the person's body. While some people recover within 3 days, for some it may take a little longer. You can return to work after 7 days of rest.