FAQs

Click on the headings below to learn more about the services that Rakesh Jayaswal offers.

General Questions

How safe is it?
Both cataract surgery and lens implant surgery have a very good safety record. It is however, an operation, and no operation is without some risk. Fortunately, significant problems or complications are very rare. An important part of the consultation is the discussion of risk with the person considering surgery. Further detailed discussion of risk can be found in our cataract booklet or the lens implant surgery booklet.

Do I need to stay in hospital overnight?
No – the surgery is carried out as a daycase. You will probably be in the day care unit for approximately 2-3 hours in total

Does the lens implant wear out?
No – the lens is made from a high-tech acrylic polymer that is completely inert. There are no moving parts, so the lens can’t wear out.

When can I have my cataract treated?
You may wish to have your cataract treated as soon as your vision interferes with your daily life and your ability to work, read, or do the things that you enjoy. If you have a driving licence you must reach the drivers and vehicle licensing authority (DVLA) standard. You can download their leaflet here and more details are available from the DVLA website.

Do you treat both eyes at the same time?
There are some surgeons who do both eyes at the same time, and it is probably safe to do so. However, common practice is to treat one eye at a time. The main advantage is to see what the outcome is like for the first eye – this sometimes allows slight modifications to the lens power for the second eye to better suit the requirements of the patient.

Why can’t I have laser treatment?
The main reasons for being suitable for lens implant surgery and not for laser are:
– Having too great a spectacle error
– The laser works by removing tissue from cornea, the clear structure at the front of the eye. This re-shapes the cornea, altering its focus. The more short-sighted you are, the more tissue has to be removed. Above a certain amount, there may be not enough tissue remaining to maintain the strength of the eyeball, and the cornea may “buckle” and cause visual problems. This is known as ectasia. Additionally, the predictability of the treatment falls off significantly the more short-sighted you are.
– Significantly long-sighted or hyperopic people are unsuitable because of the predictability of the treatment is poor. The shape that the laser has to create on the cornea to steepen it is complex, and under-correction, over-correction and irregularity are more common the higher the attempted correction.
– Having some cataract: it’s quite common for people to develop a degree of cataract even though they don’t notice an effect on their vision. The cataract is likely to develop, albeit slowly in some cases, but this change in the lens is often accompanied by a change in spectacle requirement. This means that an initially good result from laser treatment doesn’t last, and patients find that their spectacle requirement increase again with time.
– Being too old: patients over the age of 40 would, if their distance vision were completely corrected, need readers afterwards, sometimes straightaway. There are some ways round this, for example you can have what is called ‘monovision’ where one eye is deliberately made slightly short-sighted so that you effectively see distance with one eye and close with the other. Some people can’t cope with the imbalance, although most find it acceptable.

 

The Procedure

What if I cough / move / blink during the operation?
Before the procedure starts, you will be made comfortable on a bed, and there is a specially shaped pillow to rest you head in. This minimises any movement, although keeping still is important. A gentle metal spring device is used to hold the eyelids apart. An anaesthetic, in the form of drops or delivered via a blunt tube, freezes the eye so you won’t feel any pain that might cause you to move. A nurse or orderly will hold your hand if you wish during the procedure, and you can indicate if you feel the need to cough or sneeze, and the procedure can be paused.

Will it hurt?
Significant discomfort is unusual, but a sensation of intermittent pressure can be noticed.

Will I see anything during the surgery?
Right at the start there may be some vision, but very quickly this gets very blurry. Vague shapes and movements may be seen, and some notice coloured lights.

How long does the surgery take?
The procedure usually takes between 10 and 15 minutes to complete, but sometimes takes longer.

I’m quite nervous – can I be sedated?
It’s quite normal to be apprehensive before surgery. Usually, once patients realise that there is no significant pain or discomfort involved, they relax. If the patient is very anxious, then we will organise either having a light sedative tablet beforehand, or even in some cases, having a general anaesthetic.

 

Afterwards

Will I need to use eye drops afterwards?
Yes – these are normally used to up to four weeks after the procedure. Full instructions are given on the day of surgery.

Will I need glasses afterwards?
Most cataract and lens implant surgery patients will have clear distance vision but require reading glasses, unless a multifocal lens has been implanted or there is monovision. Some people, even if they have had a multifocal lens implanted, will glasses for some tasks.

What do I do between my procedures as far as glasses are concerned?
We will provide specific advice tailored to the individual. This may be to wear just one contact lens, or go without glasses.

Can I bend down to pick things up?
Yes, but don’t lift any heavy weights (something that would cause you to hold your breath). We advise patient s to avoid heavy gardening duties for a week or so.

How soon can I exercise after surgery?
Gentle low-impact exercise can be resumed after a few days. High impact activities such as running ought to be avoided for at least a fortnight. You should avoid swimming for a fortnight.

When can I start to use eye make-up?
Avoid mascara for at least two weeks. Other products such as eye shadow may be used after a week.

When can I drive?
Driving can be resumed can drive as soon as you feel comfortable and confident, and as long as you can read a standard car number plate in daylight from 20 metres away (about three car lengths).

Can the cataract come back or regrow?
No. The membrane behind the lens can become a little cloudy in the months or years after surgery, and if that is significant, some will require an outpatient laser treatment with a special laser, the yag laser.

When can I return to work?
This depends on your job. If you are office-based, then usually within a few days you should be comfortable enough to return to work. If you work in a dirty or dusty environment, then it may be longer before you can safely return.

When can I fly?
Flying as a passenger is possible the day after surgery. If you are a pilot, then the civil aviation authority will need to clear you before you can fly.

Will my vision change as I get older?
Changes in the natural lens are usually the reason why peoples vision changes as they get older. After a lens implant, the vision should be much more stable. Small changes in the requirement for glasses are however possible in the future.

RLE

Am I suitable?
Lens implant surgery is suitable for people who are motivated to reduce their reliance on glasses or contact lenses, and who are not candidates for laser treatment.

Those who tend to seek treatment include:

  • Those who wish to be able to read without glasses, and who also need glasses for distance
  • Those who have high prescriptions (either long or short-sight)
  • Those who are starting to develop some cataract

It’s also relatively important that you are in good general health and have had no previous significant eye problems.

What types of IOLs can be used?
Single focus lens implants
Monofocal lenses have a single focus that is normally set for distance vision. Used for over 50 years in eye surgery, they are an excellent and reliable method of improving the distance vision. Glasses are rarely required for distance vision, they have few unwanted side effects, but spectacles will almost certainly be needed for near and middle range vision.

Multifocal lens implants
These provide a great solution for people who prefer not to wear spectacles for most activities but who accept they may be needed for visually demanding tasks such as reading very small print or reading in dim light.

Accommodative lens implants
These lenses adapt within the eye depending on the distance viewed, reducing the need for glasses after surgery. The degree to which they adapt can vary from person to person and therefore the result can be less predictable than multifocal lenses.

Toric lens implants
These lenses are an excellent way of treating high degrees of astigmatism. “Toric’ lenses can be either monofocal or multifocal in design.

Blended or Monovision
It is possible to gain a large degree of spectacle independence by implanting a lens to correct distance vision in one eye and a lens to correct near vision in the other eye. This option is best tolerated by individuals who have previously enjoyed monovision with their contact lenses, and a trial of this situation is advised beforehand.

What to expect on admission to the clinic
You will be shown to your private room.  A nurse will perform some routine investigations including checking your pulse and blood pressure.  The nurse will also record details of any medications you are taking and ask questions about your general health.

Once this has all been completed, the nurse will instil the drops, which dilate your pupil in preparation for the operation. You will also have another chance to discuss the operation with your consultant surgeon. You will be asked to sign a consent form which states that you have been provided with and understand all the information given relating to the operation (including the risks and benefits of surgery) and that you agree to the proposed treatment.

The ophthalmic nurse will come to see you to explain what will happen during and after the operation, and to answer any further questions you may have.

You will be taken to the operating theatre in your own clothes, so it is important to wear something comfortable.

What to expect during surgery
During the surgery, you will be lying down and a theatre assistant will hold your hand at all times for comfort and reassurance. The procedure takes between 5 and 15 minutes and during this time, you will see some lights and feel some water. The procedure is painless.

Immediately after your operation
After the operation you will be taken to the recovery room, and then back to your private room. Whilst resting after the operation you will be offered refreshments.

You will be given a combination antibiotic and anti-inflammatory eye drop to take home, with written instructions on how to instil these and the frequency with which they should be used.  They are usually to be used four times a day for two weeks and then twice a day for two weeks. You may leave the hospital when you feel ready.

How quickly will your vision improve?
Your vision will improve almost immediately. The vision will continue to improve until your pupil returns to its normal size.  Thereafter the operated eye can take time to settle but you should start to notice an improvement in your vision within a couple of days.

Driving and travel
It is not advisable to drive until you feel confident to do so.  Your ability to drive may be dependent upon a number of factors, including the vision in your other eye and the quality of your vision when using both eyes together. This will be discussed with you prior to discharge from hospital.

If you are in any doubt regarding your visual status you should refrain from driving until you have been seen for review in the clinic.

It is acceptable to travel (including by air) following lens surgery.  However, please remember that you will need to continue putting drops in the eye for approximately four weeks.

What shall I do with my glasses?
After the first operation, many people find they can go without glasses and use the operated eye; others will use their glasses and use the unoperated eye. Sometimes, if the lens is removed from the operated side of the pair of spectacles this will help. However if the prescription is strong this may not be comfortable due to the imbalance between the two eyes.

If you wear contact lenses the best solution is to wear the contact lens in the unoperated eye only.

A follow-up appointment in the outpatient clinic is usually arranged a week later, and the second eye operation is done two to four weeks later.

Cataract

What happens in Surgery?
Lens replacement is one of the safest and most effective surgical procedures. Each year in the UK alone, it is estimated that there are over 340,000 lens replacement procedures carried out to treat cataract alone.

The operation involves removing the natural lens through a tiny 2.2mm incision. Once the natural lens has been removed, s new replacement lens called the ‘intraocular lens, is gently inserted through the same small incision and set into its permanent position.

Is the surgery painful?
No. Anaesthetic eye drops are used in conjunction with a mild sedative if required to make this a painless procedure.

What is the recovery period?
98% of patients are legal to drive themselves the next morning. You can start reading and watching TV immediately. Most patients recognize a significant visual improvement immediately after surgery. Your vision continues to improve for about one week. We provide over the counter reading glasses while your eye heals. If patients want or need glasses they can be prescribed anytime after the first or second week.

When can I go back to work?
Most cataract patients can resume their work and everyday tasks within a few days of their surgery. You can lift and bend over but it is advisable to keep clear of physically demanding activities in the early recovery stage. You can wash your hair at any time but it is best not let water come in direct contact with the eye for 1 week.

What are the risks?
Approximately 400000 cataract procedures are performed in the UK each year and as many as 10 million worldwide. Naturally, with that many procedures there will be reports of almost every possible complication. Our data shows a complication rate lower than 0.5% with 99.5% patients having an excellent post-operative course and an excellent visual result. Infection occurs in less than 1 in 5000 cases and retinal detachment occurs in less than 1 in 3000 cases.

Other complications including corneal decompensation, persistent macular edema, implant instability, power calculation errors, and glaucoma. All of these problematic cases add up to less than one half percent. In almost all of these cases further surgery, additional medications, or additional time results in recovery and a net improvement in vision. It is extremely rare for patients to end up worse than they started.

How safe are the implants?
Extremely safe. The development of the intraocular lens was the single most important development in the field of Ophthalmology and Optometry over the last century. The refinement in lens design, materials, and manufacture since the 1940’s is one of the great medical success stories. Implants used since 1990 are safe, reliable, and effective.

What do you need to do for your preoperative consultation?
If you use soft contact lenses you must refrain from wearing them for one week before your consultation; if you use rigid gas permeable lenses please stop wearing them for 4 weeks before your consultation. The examination will be thorough and included the use of drops to dilate your pupil. This can lead to blurred vision and so it is advisable to arrange not to drive to your consultation.

We would like you to be aware of any prescribed medications you are taking. You will probably be asked to continue these in the usual way, but some medications can cause complications during ophthalmic procedures.

These include warfarin, an anti-clotting agent; and tamsulosin (Flomax) or similar preparations given to some men with prostate problems. If you normally take these it is important you that let us know prior to admission. If you take a diuretic “water tablet” and are having surgery on a morning operation list, you may wish to postpone taking it until after your operation.

What type of anaesthetic will you have?
Most cataract procedures are carried out under local anaesthetic, using just drops to numb the eye (referred to as “topical anaesthesia”). However some patients find there is a desire to squeeze the eye closed. In this case a small injection around the eye is performed to reduce eye and eyelid movement (known as a sub-tenons local anaesthetic).
With this type of anaesthetic there are no restrictions; you may eat and drink prior to admission. There is no pain during surgery and it is possible to leave hospital about an hour after the operation.

How long will the implanted IOL last?
The IOL implants are usually left in place for life, they are biologically inert and are made from acrylic polymers.

What are the risks of cataract surgery?
Rakesh has performed many thousands of cataract operations. He ensures that the technology and products used for the surgery are of the highest standards available. He operates using state of the art equipment with facilities for sedation and general anaesthesia if required.

Although the vast majority of patients achieve excellent results without complications, it should not be forgotten that cataract removal is a surgical procedure. As with all forms of eye surgery, cataract removal has risks and whilst we make every effort to minimise them they cannot be totally eliminated.

Although rare, the most common risks include:

  • Retinal Detachment: this is when the interior surface of the back of the eye (the retina) becomes detached from the wall of the eyeball.  If surgical correction is not successful it can result in severe loss of vision.  The risk is increased for highly myopic patients.
  • Infection: Whenever an incision is made in the eye it is possible to contract an infection which could potentially cause visual loss.  Due to the quality of our hospital theatre environment and our surgeon’s skill, this is extremely rare.  As an added precaution we prescribe antibiotic eye-drops for compulsory use after the operation.
  • Macular Oedema: This is an accumulation of fluid at the central retina which can cause a temporary or permanent reduction in vision after surgery.  The drops we prescribe reduce the risk of this occurring.
  • Floaters: These floating objects are often experienced after surgery but usually settle over time.
  • Other complications: tearing of the lens capsule which can make it difficult or impossible to position the lens implant; bruising around the eye or double vision resulting from local anaesthesia; a temporary increase in the intra-ocular pressure.

How quickly will my vision be restored?
Your vision will be slightly blurred for a few days while your eye heals. It is not uncommon to feel some discomfort, usually a feeling that something is in the eye until your eye settles but there should be no pain.  After a couple of days you will start to notice a significant improvement in your vision.  You can quickly return to many everyday activities, although heavy lifting or other strenuous activities should be avoided for a week. The healing eye needs time to adjust so that it can focus properly with the other eye, especially if the other eye has a cataract. Ask your surgeon or optometrist when you can resume driving.  You will see the surgeon again after 2 weeks and will visit your optometrist for new glasses after 6 weeks.

Once you have been given your new glasses, you may notice that everything seems a lot brighter than you remember. Colours may be sharper and may have a blue-ish tinge. In bright sunlight you may feel you are looking through rose-coloured glasses. These colour tinges are normal and are because you are now looking at the world through a clear lens that is no longer cloudy. Within a few months your brain will get used to your new clear vision and these colours should go away.

Will both eyes be done at the same time?
Surgery will normally take place with an interval of one week or less between each cataract surgery procedure.

Can I fly following surgery?
You can fly on the day of surgery but it is advisable to remain local to the hospital for the first few weeks after surgery.

Corneal Transplant

What results may I expect?
The outcomes of corneal transplantation have been most extensively studied using data from the Australian Corneal Graft Registry. Broadly, these outcomes can be divided into two major groups: Visual outcomes and survival outcomes. Both groups depend very much on the condition of the eye prior to the graft being performed.

Conditions which result in inflammation, infection or blood vessels entering the eye are associated with worse outcomes than those which do not. Pregnancy, prior blood transfusion and a failed previous graft are also recognised as risk factors (albeit lesser) for graft survival. Overall approximately 60% of grafts are functional at 10 years(rising to >90% in the best cases). Visual outcomes also vary according to the reason for which the graft was performed.

Are there any risks with the surgery?
All operations carry the risk of complications whether from the anaesthetic, surgical procedure, subsequent medical procedures e.g. removal of stitches or any drugs e.g. eye drops which need to be taken.

The risk of retinal detachment following a corneal transplant is estimated at about 2% (twice that for cataract surgery), and sight threatening infection about 1% (five times higher than for cataract surgery).  The donor material is screened for HIV, Hepatitis and the presence of bacterial infection and is assessed for quality at the Eye Bank in Bristol administered by the UK Transplant Centre. There always, however, remains a risk that a serious transmissible disease may be passed from the donor to the recipient although that risk is thought to be extremely small (<1%).

What actually takes place during the operation?
Corneal transplant surgery for keratoconus is usually performed under general anaesthetic (the patient is asleep) but can be performed whilst the patient is awake. A central disc of cornea (approximately 7 to 8mm across) is carefully removed from the patients eye. It is replaced with a matching disc of tissue is taken from the donor cornea (this is the corneal graft), and stitched into place with very fine nylon stitches.

How long does the operation take?
A full thickness corneal graft or “penetrating keratoplasty” takes about an hour. Partial thickness or “deep lamellar keratoplasty” takes one-and-a-half to two-and-a-half hours. If any other surgery is planned, such as cataract surgery, then it will take longer.

For laser assisted surgery,the surgery is performed in two stages on the same day. The laser incisions are performed in the laser suite. This only takes a few minutes and is performed under local anaesthetic. The patient is transferred to the operating theatre where the rest of the operation is performed under general anaesthetic.

How long will I be in hospital?
Usually you will come in on the day of surgery with the operation scheduled for first on the operating list. You will almost always be able to go home later that same day.

What will it feel like after surgery?
Your eye will feel irritable and gritty and probably still blurred in the first week or two, and it might be slightly painful. If you are working we advise at least two weeks off work. After the first 24 hours severe pain should not occur – if it does you should contact the eye clinic.

The improvement in vision will depend on what the vision was like before the graft. Many eyes undergoing corneal graft are very blurred, and so there is often a slight to moderate improvement even after the first few days. However, as the cornea heals relatively slowly, it may take a few months before the vision improves significantly, so patients have to be patient.

Will I need drops after the operation?
Yes. Initially an antibiotic drop four times a day for about 2 weeks, and also a steroid drop four times a day. Steroid eye drops are very important to prevent rejection of the graft and they are used for a year or more. However by the end of the year they are only put in once a day. It is vitally important not to run out of steroid drops.

How often will I need to be seen after the operation?
You will be seen a day or two after the day after the operation. Your next visit is usually one or two weeks later. We then increase the period between visits, often to four weeks, then three months etc. This will depend on each individual.

You can expect to be seen at least six times in the first year. It is likely that you will need to be seen once or twice a year for the first few years.

Is there anything I should avoid after the operation?
You can do most things, but try not to bump the eye. Swimming pools are an infection risk, so avoid swimming for a month. It is safe to fly, unless you have been told that air has been used inside the eye during the operation.

Could I catch any disease from the transplant?
The medical history of the donor is checked to exclude the following conditions: rabies, Creutzfeldt-Jakob disease [CJD] and diseases of the nervous system of unknown cause. Blood is taken from all donors to exclude hepatitis B, hepatitis C and HIV. While the cornea is in the Eye Bank in Bristol it is very carefully examined to reduce the risk of infection with bacteria and fungi; as a result of these checks the risk is tiny (much less than 1%). However, because of this tiny risk, once you have had a corneal transplant you will not be able to be a blood or organ donor.

How well will I see?
Visual recovery is slow and varies from patient to patient. The eye can be shortsighted, longsighted, or have significant astigmatism leaving the vision blurred. Vision can be corrected using glasses, or sometimes even a contact lens. The majority of patients over 80% of patients will obtain legal driving vision in the eye after the transplant.

Alternatively patients can undergo further smaller procedures such as refractive laser surgery to improve the vision if required.

Why and how are the corneal stitches removed?
The stitches used do not dissolve, as this would lead to them disappearing too soon. If left in forever they will eventually become loose and irritate. Depending on how the eye is settling the sutures are usually removed between 6 months and 2 years. They are usually removed in the operating theatre, but it is a simple procedure. It takes about 20 minutes, with the eye anaesthetised simply with drops.

Occasionally a stich comes loose before this time, it will feel irritating, and is best removed as soon as possible in the clinic.

How long will the graft last?
Deep Anterior Lamellar Graft (DALK) One of the great benefits of a DALK is that it will usually last for the patients life time.

Trauma risk
A grafted cornea remains structurally weaker forever. A graft can be ruptured from a blow to the eye. Therefore contact sports such as football are very risky indeed, and even less risky sports like tennis, squash should not be played without good eye protection. A ruptured graft can be disastrous for the eye and lead to blindness.

What problems should I seek advice about?
Graft rejection is the main concern (much less common in lamellar grafts). This rejection results from your immune system recognising the graft as being “foreign”. The eye becomes red, sore, sensitive to light, and the vision becomes blurred. This is very treatable, but if not treated early, can lead to permanent graft failure with blurred vision. Sometimes a stitch becomes loose and it feels like something is in the eye. This also needs to be dealt with quickly as a loose stitch can provoke rejection.

Keratoconus

What is the procedure?
The procedure takes about 15 minutes and is done on an outpatient basis, but you will need someone to drive you home after surgery. Before surgery, your surgeon places anesthetizing drops in your eye and may give you a mild oral sedative.

During the procedure, your surgeon uses a femtosecond laser to create a channel between layers of the cornea, outside of the central optical zone. Your surgeon then chooses the appropriate ring thickness. A thicker ring in Intacs means more flattening of the cornea, which increases the level of vision correction achieved. After one or two crescent-shaped Intacs are inserted into the tunnel, the procedure is over.

After Intacs Surgery
You’ll probably rest for a while, then go home (have someone else drive you). Most people have sharper vision the first day after surgery, but you may need a couple of days of relaxation to promote healing. You won’t feel the ring segments, because they are beneath the cornea’s nerve endings. Other people can’t see them unless they look very closely into your eyes.

The ring segments flatten your cornea similarly to the way you can flatten the top of a tent by pushing on the sides.

Results of these implants will depend on the degree of keratoconus in each individual. People with milder cases of keratoconus may not need any lenses for additional vision correction. People with moderate keratoconus may require glasses or soft contact lenses for improved vision.

For more advanced cases, rigid gas permeable contact lenses may be needed to improve vision or to delay or prevent the need for a corneal transplant.

Intacs can be very effective at changing the cornea and flattening the cone caused by keratoconus. But if you have advanced keratoconus, Intacs cannot halt the progression caused by weakening of surface eye tissue (collagen) responsible for corneal strength.

Results of Clinical Trials for Intacs for Keratoconus
In 58 keratoconus eyes implanted with Intacs, almost half (25) achieved 20/40 uncorrected vision or better in a study reported in the October 2005 issue of Archives of Ophthalmology. Studies also have shown that Intacs may be able to reduce vision distortions in people with keratoconus who also have developed irregular astigmatism associated with an uneven eye surface.

In another study, single-segment Intacs improved both uncorrected vision and lens corrected vision for LASIK eye surgery patients who developed keratoconus or progressive corneal thinning (ectasia) as a complication. Single-segment Intacs also were more effective than double-segment Intacs in the same study reported in the May 2006 issue of American Journal of Ophthalmology.

Among 28 people in the post-LASIK study, 37 eyes were treated with either single-segment or double-segment Intacs. Each group was matched for factors such as age. The single-segment group averaged about nine lines of uncorrected vision improvement on a standard eye chart, compared with 2.5 lines in the double-segment group.

Results of Clinical Trials for Intacs for Nearsightedness
A literature review of 452 patients who underwent Intacs corneal ring implantation for the correction of nearsightedness was published in the October 2001 issue of Ophthalmology.Twelve months after surgery, 97 percent of treated eyes had 20/40 vision or better, and 74 percent had 20/20 or better.

Just under 9 percent of patients requested to have their Intacs removed due to side effects such as glare, halos and night vision problems or because their vision was under- or over-corrected, and 3.8 percent required a secondary surgical procedure. There were no serious complications.

A study of the reversibility of Intacs for nearsightedness, published in the January 2001 issue of Journal of Refractive Surgery, found that 20 of the 21 eyes returned to within 1.0 diopter of their preoperative refraction, with stable vision three months after removal was performed safely and without complications.

Am I a Candidate for Intacs?
If you are considering Intacs surgery for keratoconus, your first step is to have a comprehensive eye exam by an ophthalmologist who specializes in the procedure. He or she will examine your eyes and perform a number of measurements to determine if the procedure is likely to improve your vision.

If you are interested in Intacs corneal ring implantation for the correction of nearsightedness, you must be at least 21 years of age and have a stable eyeglasses prescription with no more than -3.0 diopters (D) of myopia and no more than 1.0 D of astigmatism.

After examining your eyes, your eye doctor can tell you more about Intacs. The cost of the procedure varies from surgeon to surgeon, but generally Intacs cost slightly more than laser vision correction.

Are Intacs Inserts Right For Me?
The best way to determine if Intacs corneal implants are right for you is to consult a doctor who specializes in Intacs corneal implants, who can give you all the facts and evaluate your eyes.
Cross Linking

What are the risks of Cross Linking?
Risks of the procedure (to all structures of the eye) are minimal. The main risks are infection, and inflammation of the cornea after surgery but these risks are extremely low. Rigorous observation of the indications and contraindications has been conducted.

After Cross Linking, patients often experience:

  • Post-operative pain and sensation of foreign body in the eye for 24-48 hours after treatment until re-epithelialisation is complete
    • Watering of the eye for 24-72 hours after treatment
    • Transient corneal oedema with visual blurring for 30-60 days after treatment
    • Corneal haze usually occurs but clears in the first 8 weeks

 

Corneal Transplantation Surgery

What actually takes place during the operation?
Corneal transplant surgery for keratoconus is usually performed under general anaesthetic (the patient is asleep) but can be performed whilst the patient is awake. A central disc of cornea (approximately 7 to 8mm across) is carefully removed from the patients eye. It is replaced with a matching disc of tissue is taken from the donor cornea (this is the corneal graft), and stitched into place with very fine nylon stitches.

How long does the operation take?
A full thickness corneal graft or “penetrating keratoplasty” takes about an hour. Partial thickness or “deep lamellar keratoplasty” takes one-and-a-half to two-and-a-half hours. If any other surgery is planned, such as cataract surgery, then it will take longer.

For laser assisted surgery,the surgery is performed in two stages on the same day. The laser incisions are performed in the laser suite. This only takes a few minutes and is performed under local anaesthetic. The patient is transferred to the operating theatre where the rest of the operation is performed under general anaesthetic.

How long will I be in hospital?
Usually you will come in on the day of surgery with the operation scheduled first on the operating list. You will almost always be able to go home later that same day.

What will it feel like after surgery?
Your eye will feel irritable and gritty and probably still blurred in the first week or two, and it might be slightly painful. If you are working we advise at least two weeks off work. After the first 24 hours severe pain should not occur – if it does you should contact the eye clinic.

The improvement in vision will depend on what the vision was like before the graft. Many eyes undergoing corneal graft are very blurred, and so there is often a slight to moderate improvement even after the first few days. However, as the cornea heals relatively slowly, it may take a few months before the vision improves significantly, so patients have to be patient.

Will I need drops after the operation?
Yes. Initially an antibiotic drop four times a day for about 2 weeks, and also a steroid drop four times a day. Steroid eye drops are very important to prevent rejection of the graft and they are used for a year or more. However by the end of the year they are only put in once a day. It is vitally important not to run out of steroid drops.

How often will I need to be seen after the operation?
You will be seen a day or two after the day after the operation. Your next visit is usually one or two weeks later. We then increase the period between visits, often to four weeks, then three months etc. This will depend on each individual.

You can expect to be seen at least six times in the first year. It is likely that you will need to be seen once or twice a year for the first few years.

Is there anything I should avoid after the operation?
You can do most things, but try not to bump the eye. Swimming pools are an infection risk, so avoid swimming for a month. It is safe to fly, unless you have been told that air has been used inside the eye during the operation.

Could I catch any disease from the transplant?
The medical history of the donor is checked to exclude the following conditions: rabies, Creutzfeldt-Jakob disease [CJD] and diseases of the nervous system of unknown cause. Blood is taken from all donors to exclude hepatitis B, hepatitis C and HIV. While the cornea is in the Eye Bank in Bristol it is very carefully examined to reduce the risk of infection with bacteria and fungi; as a result of these checks the risk is tiny (much less than 1%). However, because of this tiny risk, once you have had a corneal transplant you will not be able to be a blood or organ donor.

How well will I see?
Visual recovery is slow and varies from patient to patient. The eye can be shortsighted, longsighted, or have significant astigmatism leaving the vision blurred. Vision can be corrected using glasses, or sometimes even a contact lens. The majority of patients over 80% of patients will obtain legal driving vision in the eye after the transplant.

Alternatively patients can undergo further smaller procedures such as refractive laser surgery to improve the vision if required.

Why and how are the corneal stitches removed?
The stitches used do not dissolve, as this would lead to them disappearing too soon. If left in forever they will eventually become loose and irritate. Depending on how the eye is settling the sutures are usually removed between 6 months and 2 years. They are usually removed in the operating theatre, but it is a simple procedure. It takes about 20 minutes, with the eye anaesthetised simply with drops.

Occasionally a stich comes loose before this time, it will feel irritating, and is best removed as soon as possible in the clinic.

How long will the graft last?
Deep Anterior Lamellar Graft (DALK)
One of the great benefits of a DALK is that it will usually last for the patient’s life time.

Penetrating Keratoplasty (PK)
Penetrating keratoplasty (PK) may not last as long but usually last 10 to 20 years. But if a PK fails it is quite possible to repeat the procedure. If a penetrating keratoplasty fails it will become cloudy giving misty vision. The most common cause for failiure of the cornea is loss of the endothelilal cells on the inner surface of the cornea. These can be lost naturally and slowly over time or more rapidly in the case of corneal graft rejection. If this leads to loss of a critical number of cells the graft will fail and vision will become misty. Some eyes carry more risk than others. For example, an eye grafted for keratoconus has a better prognosis than one grafted for herpes simplex keratitis scarring. The 5 and 10-year survival for a full-thickness graft for keratoconus is 97% and 92% respectively. For all full-thickness corneal grafts it is 90% and 80%. The figures are much better for deep lamellar grafts.

Trauma risk
A grafted cornea remains structurally weaker forever. A graft can be ruptured from a blow to the eye. Therefore contact sports such as football are very risky indeed, and even less risky sports like tennis, squash should not be played without good eye protection. A ruptured graft can be disastrous for the eye and lead to blindness.

What problems should I seek advice about?
Graft rejection is the main concern (much less common in lamellar grafts). This rejection results from your immune system recognising the graft as being “foreign”. The eye becomes red, sore, sensitive to light, and the vision becomes blurred. This is very treatable, but if not treated early, can lead to permanent graft failure with blurred vision. Sometimes a stitch becomes loose and it feels like something is in the eye. This also needs to be dealt with quickly as a loose stitch can provoke rejection.

Testimonials

“Just thought I would drop you a quick line, since you carried the operation which I think must have been 3 years ago, it has totally changed my life, that was one of the points you made when I attend for the consultation.”