Recovery periods of CXL and INTACS???

[h_dufresne]

I was diagnosed with KC just less than two years ago at age 17. I regularly wear RPGs for 12hrs a day getting 20/30 vision with them. Currently that is adequate for me to study normally as a 2nd year medical student.

I put up with the discomfort and I am hopeful of getting a more comfortable fit with the new Synergeyes ClearKone hybrid lenses in future.

I'm grateful for the vision I have and desperately want to retain it, hence after two years of putting KC to one side and getting on with University etc, I am eager to get corneal cross-linking (CXL) treatment to prevent any sudden progression.

However, as my KC is mild there still remains the option of INTACS and the hope that a more regular shaped cornea could offer both a more desireble lens fit and improved corrected visual acuity (potentially with soft lenses or glasses though extremely unlikely.)

I understand that having done CXL done before the INTACS would be pointless and so feel the need to make a decision on having INTACS or not now. Although obviously CXL does not rule out INTACS at a later date, I want whatever treatment I have done to have as little impact on my studies as possible.

I would be extremely grateful for any answers to the following questions.

1) How long would I expect to allow for the recovery periods of each of these procedures? (How long off uni/work? How long without contacts? etc.)

2) What are people’s experiences of the benefits and risks of INTACS? As my eyes are already sensitive to bright daylight and streetlights and night etc I am worried about the discomfort, glare and enhanced halo effect and that they would outweigh the benefits.

Many thanks,

Henry

[Anne Klepacz]

Hello Henry and welcome to the forum,
Neither CXL nor Intacs were around in my day, so can't offer you any personal experience. But from all I've read from forum users here, recovery from both these procedures seems to vary a lot from one person to another. And while time off work/study may only be a week or two, vision can continue to fluctuate for 6 months or more. But I'm sure other people will be along to tell you how it was for them. Meantime, if you'd like the DVD of our 2009 conference which covered all the current options for KC, including CXL and Intacs, do e-mail your postal address to anne@keratoconus-group.org.uk and I'll put one in the post to you.
All the very best with your studies - good to see another medical student here!
Anne

[caroline6505]

Hi

I had crosslinking in my right eye about a month ago (I'm due to have crosslinking in my left eye next week). I was absolutely fine and was walking about and going about as normal the following day. I'd heard a lot about the pain, but genuinely only experienced mild discomfort. I'm a graphic designer and so stare at a vdu for 8 hours a day. I took a week off before returning to work. Since the crosslinking, I've found that my eyes are a bit more light sensitive than usual. It's very difficult to say whether my vision has stayed the same or not (I suspect there may only be a marginal change). I'm curious that you've said it would be pointless have CXL before INTACS as my surgeon has mentioned this (he's also spoken about a wedge resection) and so the fact that he's said this suggests that INTACS can be done afterwards (as can a wedge resection).

Best of luck in whatever you decide. I know there's been quite a few members that have posted recently after having recently undergone crosslinking.

Caroline.

[dalbeath]

I had CXL done a few weeks ago, I was in quite a lot of pain for the first 48 hours but after a week was back to work and feeling fine - am also studying for exams and was back to study after a week.

I wear piggy back lenses and got them back in after 20 days. My eyes are still light sensitive but sunglasses when outside fix that also driving etc.

Good luck!

[h_dufresne]

Thank you both for your posts.

Caroline, from what I have read I understand that after a procedure which significantly alter the shape of the cornea, CXL is required if the shape is to be maintained and further progression prevented (someone please correct me if I am wrong!!)

If it is the case that CXL done prior to INTACS would be sufficient in preventing progression even after having INTACS put in then I would be able to have CXL and delay making a decision on the INTACS. Otherwise it would surely make sense to have it all done in one treatment wouldn't it??

Is it worth me trying CXL on its own before INTACS? Why didnt you go straight for the INTACS or wedge resection?

[caroline6505]

Hi

I was diagnosed with Pellucid Marginal Degeneration in April and so all of this is new to me and so I'm out of my depth advising anyone else. However, I was advised (Centre for Sight) that the best that I could hope for with crosslinking was to halt progression of the condition and strengthen the corneas. Also, it takes around 3 months for a crosslinked cornea to stabilise hence the reason why it's not practical to have e.g. INTACS or a wedge resection done at the same time. I do believe that a few people report slight improvement or deterioriation in vision – again, I understand that there can be slight changes in the thickness of the cornea. I was advised that INTACS (to a degree this can reshape and improve vision – it's an option that can be removed without detriment) could be an option in a couple of months time or alternatively a wedge resection and so I'll hopefully find out more next week what the plan of action is. The only thing I can advise is to seek some professional advice.

Best wishes.

Caroline.

[Lizb]

Depending on the consultant depends on whether they recommend intacs then cxl or cxl then intacs. I had the latter on my left eye. I have since been fitted successfully and comfortably with kerasoft 3 lens. Prior to the operations i couldnt get on with contact lenses for any length of time, it has only taken two fitting sessions this time round. I have had a reduction from -10 diopters to -7 diopters following the two surgeries.

I had two weeks off work following both surgeries, spend all day on a computer in false light so quite tough on the eyes. I do also suffer with dry eye. Painful after both surgeries for about 18-24 hours, though this was managed with co-codamol both times. Was very light senstive after cxl (imagine scratching your eye and then looking at bright sunshine), not so much after intacs. Drops helped a lot. I was able to watch tv and use my own computer for short periods of time, which increased in time from the surgeries.

[h_dufresne]

Thank you very much for your reply Liz. With regard to both visual acuity and glare/halo-ing, how does your current vision compare to how it was before and after having the INTACS put in?

How long after the surgey was it until you had contacts fitted? Presumably this would be longer if I were to be fitted with RPGs or hybrids.

Also was there a particular reason why your consultant recommended having the CXL before the INTACS? Do you have INTACS in your right eye as well?

[bongoland1]

Hi Guys,

I have recently had intacs placed into my right eye, which is my more keratoconic eye. I had the procedure done 6 weeks ago after CXL in June 2008. Vision without hard lenses was very poor before but my vision with lenses was outstanding (although i do struggle with red eyes and dry eyes which drops do not really help).

My goal is to considerably improve the irregular astigmatism (about -8 before intacs) to a point where glasses are more effective and/or i can tolerate softer lenses such as the kerasoft range. Best case for me would be better spectacle corrected vision in my right eye to the point where I can have a toric lens implanted before proceeding to my tackling my left eye, which is stronger and where I had CXL performed earlier this year. I am also very curious as to how vision changed post intacs and how long it took to get back into contact lenses.

Kind Regards,
Bongoland

[Lizb]

I had my intacs surgery last november, and was cleared in April this year to start trying CL. I am in Kerasoft 3 lenses, went with this option mainly because we had tried every other option previously and my CL fitter had since obtained the kerasoft 3 fitting sets - one of the previous attempts of CL I tried was a previous version of kerasoft lenses.

My uncorrected vision wasnt much different pre and post op - the board wasnt so close to me before i could see the top letter on the board. I havent had many issues with glare/haloing either pre or post op - light senstivity only when my eyes are dry or having a allergic day.

When i had the CXL done (privately), the consultant recommended CXL first to strengthen the cornea before intacs were inserted, as if the cornea wasnt strengthed first then the intacs wouldnt necessary stay in the right place, leading to the potential that they would need to be replaced to get the best vision. However I then had intacs done on the NHS by a different consultant, who prefers intacs followed by CXL, based on the reasoning how can intacs reshape the eye if the cornea is "stronger". I can see both points of view.