Corrective surgeries for keratoconus are often performed in outpatient surgery centers (OSCs), with no overnight hospital stay required. These surgeries include intracorneal ring segment implantation, corneal collagen cross-linking, various other keratoplasties, and corneal transplantation. However, people with keratoconus who have specific health disorders may be required to undergo surgery as a hospital inpatient.
Typically, the cost of an outpatient surgical procedure is less expensive than one obtained as an inpatient in a hospital. Therefore – as a person living with keratoconus – ascertaining whether a health disorder may preclude your obtaining surgery at an OSC is important before you decide whether to undergo surgery if your insurance only covers 80 percent of costs.
Meanwhile, the professionals of the Precision Keratoconus Center can assist you in learning about the different types of corrective surgeries performed for keratoconus.
Bleeding Disorders and Surgery
The American Society of Hematology describes bleeding disorders as featured by the inability of the blood to clot properly (whether under-clotting or over-clotting). While hemophilia is the most widely-recognized hereditary bleeding disorder, certain medications can also interfere with normal blood-clotting. If you have keratoconus and a bleeding disorder, a cornea surgery may result in a subconjunctival hemorrhage resulting in further vision loss. Therefore, keratoconus-afflicted adults with a history of a bleeding disorder are usually not candidates for surgery in an OSC.
Heart Arrhythmias and Surgery
Atrial fibrillation (Afib) is the most common type of heart arrhythmia, and is an irregular heart-beat particularly linked to heart attack and stroke. If you are co-diagnosed with Afib (plus a history of heart attack or stroke) and keratoconus, a hospital is more likely to be considered the appropriate site for your surgery.
Since OSCs are less equipped to rapidly respond to a life-threatening emergency during surgery than a hospital, keratoconus-afflicted people co-diagnosed with Afib and a past heart attack or stroke are seldom considered acceptable candidates for surgery at an OSC.
Understanding Corneal Collagen Cross-Linking (CXL)
The Food and Drug Administration (FDA) approved corneal collagen cross-linking in 2016 (per the American Optometric Association’s website). This eye surgery – often performed in an outpatient setting – is aimed at strengthening (and stiffening) the cornea’s underlying structure to halt the progression of keratoconus. Boosting the strength and stiffness of the cornea’s collagen fibers is achieved through applying liquid Riboflavin (Vitamin B2) to the cornea, and then exposing the cornea to ultraviolet light.
According to a research article in 2018 in Cornea, there are two FDA-approved topical ophthalmic solutions for use in corneal collagen cross-linking. One is Riboflavin 5′-phosphate in 20% dextran ophthalmic solution 0.146% (Photrexa Viscous). The other is Riboflavin 5′-phosphate ophthalmic solution 0.146% (Photrexa).
The American Academy of Ophthalmology (AAO) concluded a high success rate for corneal collagen cross-linking using the standard surgical procedure termed the Dresden Protocol (that involves removal of the central corneal epithelium). However, an article in 2019 in Ophthalmology Times reported that this procedure is not appropriate for keratoconus-afflicted people with very advanced disease or particularly thin corneas.
Understanding Intracorneal Ring Segment Implantation (IRSI)
As a corrective surgical procedure for keratoconus, intracorneal ring segments – composed of polymethylmethacrylate – are implanted in the deep corneal stroma to modify the cornea’s abnormal curvature. This surgery is typically performed on keratoconus-afflicted people who have clear central corneas, but are unable to tolerate contact lenses in their eyes.
Meanwhile, three contraindications listed by the AAO are the following:
- Keratoconus-afflicted people who can achieve daily functional vision with the use of contact lenses.
- Keratoconus-afflicted people younger than 21 years old.
- Keratoconus-afflicted people who do not have clear central corneas.
Consulting with the Precision Keratoconus Center can enable you to learn more about CXL, IRSI, and other surgical interventions to treat keratoconus.