Thin Cornea Surgery Options

(0:01) Hi this is your host Dr.Rajesh Khanna,MD, Thin Cornea Specialist coming to you with the new episode of the Hangout With The Laserman.

(0:08) Today we are going to discuss somebody who is 47 years old and came for thin cornea surgery.


(2:05) So, as a thin cornea surgeon today our number one goal is the safety and avoidance of post lasik ectasia. That's why in this patient we will not offer lasik eye surgery whether it is automated micro keratones or with factosecond all laser lasik like intralase.

(2:22) Whatever the technology whenever the lasik flap is made the tensile structure of the cornea is decreased.

(2:27) So coming to the options, one option is superficial lasik which is also called epi lasik or superlasik. Superlasik is the short form for superficial lasik.

(2:40) The diffrence between the traditional lasik and superlasik is the superlasik uses no cut epi keratome to push the top layer away which is 53 microns and this happnes to be epithelium. That is why it is also termed epi lasik. This area does not contribute to the strength of the cornea so its fine to remove it and just like a scap or wound of the skin it heals back.

(3:07) So why we don't do superlasik on everybody because it take a few days to heal, like 3 to 4 days to heal and a few more days before the vision can come to 20/20 in all patients. Some patients it can come sooner and some patients it can come later. But that would be the treatment of choice using iDesign automated technology and epilasik to achive our results.

(3:31) Other option could be presbyopic implant in the eye if the patient does't want to wear any glasses for the rest of the life, not even middle or reading. Then PIE or presbyopic implant like ReSTOR, TECNIS, Symfony or Crystalens would be options.

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(3:50) If the patient was younger or even in this case patient saying i don't want PIE as i am not a good candidate for lasik. I want to get a quicker recovery and i don't mind doing another procedure in the future if needed. ICL could still be considered. Usually ICL is done under 45 years of age becasue cataract development could be higher. So if this patient was like 35 years of age ICL could be first choice.

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(4:27) ICL is available for powers minus 3 and higher. So if this was minus 9 thats a no brainer we will prefer ICL over even superlasik. Because even though superlasik is safer than lasik we have to remove certain amount of the tissue and if the amount of the tissue removed is excessive then again cornea can become weak.

(4:51) So lets say it was minus 12 then we would straight away do ICL even in a 47 year old patient who does not want PIE.

(4:58) In a 37 year old minus 8 still might prefer ICL. But if its minus 2 and patient wants some correction then epi lasik would be the choice.

(5:38) So the same person 47 years old we can give three diffrent recommendations even though they might have minus 4 refractions. So we have three people minus 4 refraction 47 year old with 460 microns. One person might say hey i want to do one procedure for the rest of my life, i do not want to wear any glasses then we would suggest PIE. But if they say we want minimum intervention whatever the least amount, i dont mind wearing glasses in the future then epi-lasik could be the choice. Third person says I want do the minimum and want to get maximum fastest recovery because I don't have a downtime or I am going out of town or I am in active military duty whatever reason might be then ICL would be a choice.



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Khanna Vision Institute at Beverly Hills, Los Angeles, Westlake Village, Inglewood, California, USA

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