Intacs AFTER corneal grafts - is it possible?, does it work?

[AndrewBosw]

Dear All,

I'm a long term kerataconus patient - my first eye (left) had a corneal graft in 1984, and then I had corneal graft on my second eye (right) in 1999. Both grafts have been stable and very good after the first few years of adjustment. I feel very blessed for this and have worked at a heavy desk job (including lots of IT and computer work) until very recently when I retired.

As far as sight, I can manage fine on a hard GP contact lens on my right eye with further correction with spectacles for all activities, and now with "occupational glasses" for computer work and reading. However, I am not using my left eye to its best. My left eye is difficult to optically correct as the corneal slope and astigmatism is very high, and contacts don't fit well. Over the years, I have tried various things like piggy backing - soft lens with a hard one on top, and more recently an incredible crafted hard lens by my optician. Neither have worked well - the recent stand-alone hard lens is the best possible fitting but still gets sore after a few hours of wear. I can do a few hours with the hard lens irregularly, and I do use it to keep the eye working etc, but my eye can't tolerate it for regular daily use every day. With the LH lens my sight is improved considerably, especially 3D sight. Although my sight is good just using the RH side contact lens, I am essentially using only the one eye without the LH eye adjustment.

I am now wondering if Intacs offer a possible route for my left eye. I'm a bit out of touch with the whole KC world as my grafts so so long ago, I have just got on with life (and new to this list today). So the first question would be is it possible to do Intacs after a corneal transplant? If so, what are peoples experience, does anyone on the list have experience with this?

I would be very cautious to do anything on a corneal graft that has been stable for 33 years in any case, but I am wondering if this is a possibility at this stage.

Best regards

Andrew

[Anne Klepacz]

Hello Andrew and welcome,
I've certainly never heard of Intacs being done after a graft and I very much doubt if it is even technically possible with the channels for the rings being close to where the donor cornea meets your own cornea. Plus that kind of surgery would risk a rejection of the graft even after 33 years! But have you ever tried scleral lenses - the one that cover the whole of the eye? They don't actually touch the cornea but rest on the white of the eye, so are often used for a steep cornea. Having said 'often', by no means all hospital eye clinics fit them and probably just a handful of community optometrists. If you e-mail me anne@keratoconus-group.org.uk with your postal address, I can send you our KC information booklet, which includes all the available options for KC available these days.

[DigiKera]

Dear Andrew,

An intrastromal corneal ring segment (e.g. Intacs) can be inserted post graft. As far as I'm concerned and as stated by Anna, any invasive surgery post graft might cause rejection, due to inflammation of the cornea. Rare occurrence, but happens. As to whether or not you can have Intacs inserted, that depends on your cornea parameters (e.g. corneal pachymetry, RMS, wavefront and topographic scans), and even if the procedure can be done, there might be better options (AKA other treatments). In addition, that also depends on the opthamologist, as opinions between them can vary, so you might want to have a second opinion. In my personal case, I have 2 personal opthamologists, and one of them was completely against the idea of a surgery. Post graft I had wavefront optimized PRK and my uncorrected visual acuity improved from 20/200 (initially I had around 20/30, but due to sutures removal my vision worsened) to 20/25, and I'm still in the healing process, so it might improves more. As said, there are many surgical option post graft, from Intacs, to PRK, ICL, micro incisions, and more. But for more information and in order to evaluate what fits and whether or not you might be a good candidate, you should discuss that with your opthamologist.

As for a surgery alternative, you might want to try out Europa scleral lens, wavefront-adjusted contact lenses (very expensive, mostly only in the USA), soft contact lenses for keratoconus (e.g. Kerasoft), or even Ortho-K.

Best regards,
DigiKera.