CXL and Intacs: Which should be done first?

[h_dufresne]

I have recently been to see two different consultants regarding both CXL and Intacs and which treatment I should have done first.

The first consultant I spoke to said have the Intacs done first. His reasoning being that CXL would stiffen the cornea and make reshaping it with Intacs considerably harder leading to a poorer result.

The second consultant who prefers to do epi-on crosslinking said that it doesn't matter either way. He said that Intacs are rigid pieces of plastic and that the added stiffness of a crosslinked cornea is negligable in comparision. He suggested having CXL done on both eyes and then trying kerasoft hybrid lenses. Suggesting I exhaust all the contact lens options available before having risky Intacs surgery with unpredictable results. (Having already tried rgps, soft lenses, piggy-back lenses and mini sclerals I am sceptical and keen to have Intacs.)

It seems to me that the best order of doing the treatments is unknown but from what I have read on the internet Intacs are done first much more commonly.

I would be very grateful for any thoughts/opinions/experience

[Lynn White]

Hi Henry,

There is a great deal to consider in this question, much of which is related to your own situation and thus ii is difficult to generalise.

First, you have to remember that whatever happens, you will most likely need to carry on wearing contact lenses post INTACs. If you have significant amounts of astigmatism (over 5.00D), then often INTACs do not work that well.

It is also a common perception amongst ophthalmologists that INTACs improve corneal shape and make CL fitting easier. It is the experience of many contact lens fitters that actually INTACs can make the fitting harder. When I teach contact lens workshops, this discussion comes up every time! So your consultant suggesting that you exhaust all CL possibilities before going to INTACs is giving you good advice. The only real exception to this is if you have a really distorted cornea where contact lenses simply won't fit on the eye well at all. If you are hoping to do away with contact lenses completely, I am afraid it is not likely unless your condition is very mild.

As for the before or after debate, I would err on the side of doing the INTACs first, then the CXL. On the other hand, CXL itself can gradually improve corneal shape. It can also have the effect of improving vision by a couple of lines when there appears to be no obvious shape change. No-one knows quite why yet!

Finally, just to clarify, KeraSoft is not a Hybrid lens, its a completely soft lens. An example of a hybrid is Synergeyes.

Lynn

[sarkac]

Dear Lynn,
Do overwear of kerasoft have any adverse effects like
a) protien deposits
b) cornea scratch
c) gas perm issues etc

I also chose not to do intacs too after my c3r, but another person came along very strongly suggesting not to use contact lenses as he had scratched his cornea n needed a transplant.
Since kerasoft is soft, and i intend ti use my lenses 12 hours in a day 365 days a year is that a alright thing?

thanks
sarkac