Roberto Pinelli MD
Scientific Director Istituto Laser Microchirurgia Oculare
Brescia, Italy
President of Italian Refractive Surgery Society
Antonio Leccisotti MD PhD
Visiting Professor School of Biomedical Sciences University of Ulster,
Coleraine, UK
and Director Department of Ophthalmology Casa di Cura Rugani
Siena, Italy
Foreword Stephen D Klyce
Jitendar P Vij
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Keratoconus Surgery and Cross-linking
© 2009, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition: 2009
9788184486506
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset
My wife Elena
and
My twins Chiara and Francesco
For their patience during the time spent away from them
— Roberto Pinelli
To
My beloved ones
— Antonio Leccisotti
5Foreword
I discovered many years ago that to truly understand a subject and to be able to distinguish between fact and conjecture, one has to read as many opinions on the subject as are available. What comes out as the distilled product is the knowledge that we all seek.
Dr Roberto Pinelli and Dr Antonio Leccisotti have assembled outstanding experts who have made recent major advances in the management and treatment of keratoconus. This is a disease that apparently affects only the cornea, yet is associated with so many other conditions. It is clear that keratoconus has a genetic basis and that a cure is not possible within current medical knowledge.
Corneal transplants have been very successful in the minority of cases requiring it, as many eyes with keratoconus stabilize at a stage where functional vision can be maintained with spectacles, and possibly with insert or contact lenses, although it is recognized that contact lenses can exacerbate progression or cause scarring. We need to find ways to predict the progression of keratoconus in the individual patient and to treat these before there is significant visual loss. So now there is the hope that keratoconus might be stabilized—even modestly regressed—with collagen cross-linking. Time will tell, but we have gone from guarded optimism to unbridled enthusiasm that collagen cross-linking may prove to be very effective in the management of ectasia, thanks to the pioneering work from Dresden!
Stephen D Klyce phd
Department of Ophthalmology
Mt Sinai School of Medicine
New York, USA
6Contributors
- Roberto Pinelli md
- Scientific Director, Istituto Laser Microchirurgia Oculare, Brescia, Italy
- President of Italian Refractive Surgery Society
- Antonio Leccisotti md phd
- Visiting Professor, School of Biomedical Sciences
- University of Ulster, Coleraine, UK
- Director, Department of Ophthalmology
- Casa di Cura Rugani
- Siena, Italy
- Ioannis M Aslanides md phd
- Consultant and Medical Director
- Emmetropia Mediterranean Eye Institute
- Heraklion, Crete, Greece
- H Burkhard Dick md
- Center for Vision Science
- Ruhr University Eye Hospital
- Bochum, Germany
- Müriel Doors md
- Department of Ophthalmology
- Academic Hospital Maastricht, Maastricht
- The Netherlands
- Daniel Elies md
- Cornea and Refractive Surgery Unit
- Instituto de Microcirugia Ocular
- Barcelona, Spain
- Michael J Endl md
- Department of Ophthalmology
- SUNY at Buffalo School of Medicine
- NY, USA
- Tarek El Beltagi md
- Professor of Ophthalmology
- Research Institute of Ophthalmology
- Cairo, Egypt
- Pierre Fournié md
- Service d’Ophtalmologie
- Centre Hospitalier Universitaire Toulouse
- Hôpital Purpan, Toulouse, France
- Jose L Güell md phd
- Associate Professor of the Universitat Autonoma de Barcelona
- Barcelona, Spain, and
- Director of the Cornea and Refractive Surgery Unit
- Instituto de Microcirugia Ocular
- Barcelona, Spain
- Fritz Hengerer md
- Center for Vision Science
- Ruhr University Eye Hospital
- Bochum, Germany
- Anne Hoyer md
- Department of Ophthalmology
- University Hospital Dresden, Germany
- Stephen D Klyce phd
- Department of Ophthalmology
- Mt Sinai School of Medicine
- New York, NY, USA
- François Malecaze md phd
- Professor at Service d’Ophtalmologie
- Centre Hospitalier Universitaire Toulouse
- Hôpital Purpan
- Toulouse, France
- Felicidad Manero md
- Cornea and Refractive Surgery Unit
- Instituto de Microcirugia Ocular
- Barcelona, Spain
- Colm McAlinden bsc (hons) mcoptom
- School of Biomedical Sciences
- University of Ulster, Coleraine, UK
- Ali A Mearza mbbs frcophth
- Consultant Ophthalmologist
- Imperial College Healthcare NHS Trust
- Charing Cross Hospital
- London, UK
- Johnny E Moore frcophth phd
- Visiting Professor
- School of Biomedical Sciences
- University of Ulster
- Coleraine, UK, and
- Department of Ophthalmology
- Mater Hospital Belfast Hospital Trust Northern Ireland, and Director of Leeson Eye Institute
- Dublin, Ireland
- Merce Morral md
- Cornea and Refractive Surgery Unit
- Instituto de Microcirugia Ocular, Barcelona
- Spain
- Institut Clinic d’Oftalmologia, Hospital Clinic i Provincial de Barcelona, Barcelona, Spain
- Rudy MMA Nuijts md phd
- Associate Professor of Ophthalmology Department of Ophthalmology
- Academic Hospital Maastricht
- Maastricht, The Netherlands
- Frederik Raiskup-Wolf md
- Department of Ophthalmology
- University Hospital Dresden, Germany
- Chitra Sambare ms frcs
- Cornea and Anterior Segment Fellow
- Consultant, Deenanath Hospital and Research Centre and Shashwat Hospital, Pune, India
- Sunil Shah frcophth frcsed fbcla
- Visiting Professor at the School of Life and Health Sciences, Aston University, Birmingham, UK
- Visiting Professor at the School of Biomedical Sciences, University of Ulster, Coleraine, UK
- Medical Director, Midland Eye Institute, Solihull UK, Consultant Ophthalmic Surgeon
- Heart of England Foundation Trust, Birmingham, UK, and Consultant Ophthalmic Surgeon, Birmingham and Midland Eye Centre
- Birmingham, UK
- Eberhard Spoerl md
- Department of Ophthalmology
- University Hospital Dresden, Germany
- Nayyirih G Tahzib md
- Department of Ophthalmology
- Academic Hospital Maastricht
- Maastricht, The Netherlands
Many aspects contribute to the fact that keratoconus is an ideal link between refractive and corneal surgery. The expansion of the options for the visual rehabilitation in keratoconus has partly originated from the progress of diagnostic and therapeutical techniques in refractive surgery. Intrastromal rings and phakic IOLs, to mention a few, were conceived to correct myopia but have found a natural and successful application in keratoconic eyes. But some of the new techniques discussed in this book were expressly ideated to strengthen (collagen cross-linking) or to replace (lamellar keratoplasty) a weakened corneal stroma. The subject of the surgery of keratoconus has therefore become so wide that no single surgeon can exhaustively cover all its aspects.
With this in mind, we wanted to gather the experience of some of the most valuable keratoconus surgeons in the world in a comprehensive book. Some of the contributors are old friends who did not let us down in this daunting task, some are new friends who honoured us by believing in our project. Everyone is an outstanding surgeon and, above all, a brilliant medical writer, this latter quality being nowadays much rarer than the former. Thanks to such collaborations, the final result has reached the excellence we had in mind when the book was first planned.
We would like to thank the entire team of Istituto Laser Microchirurgia Oculare, Brescia—Italy and the Assistants of Dr Leccisotti for their blessings and motivation.
Roberto Pinelli
Antonio Leccisotti