Collagen Crosslinking using Riboflavin (C3R) and UV light exposure for Keratoconus First IRB approved Prospective Study in India
Released on = January 18, 2007, 7:38 am
Press Release Author = Dr Rajesh Fogla
Industry = Healthcare
Press Release Summary = Collagen Crosslinking using Riboflavin and UV light exposure
for keratoconus. A new treatment that arrests the progression of disease, initiated
under an IRB approved prospective study for the first time in India at Apollo
Hospitals, Hyderabad. Keratoconus patients can enquire for eligibility for this
treatment
Press Release Body = Keratoconus is a corneal disease affecting 1 in 2000
individuals. The disease usually starts in young adults, and is characterized by
progressive thinning and outward protrusion of the cornea. (Cornea is the clear
structure in front of the human eye responsible for focusing of rays of light into
the eye for a clear image)
The cornea takes a conical shape, and produces astigmatism due to which the rays of
light cannot be focused properly, resulting in deterioration of the quality of
vision. In the early stage of keratoconus, vision can often be improved using
cylindrical correction in the glasses. However in later stages most patients require
rigid gas permeable lenses for improvement in quality of vision. Intacs are plastic
ring segments which can be inserted into the mid-peripheral cornea to produce
flattening of the central cornea. This results in reduction of the severity of
keratoconus, and improves both vision & contact lens fitting to a certain extent.
However it does not affect the progression of keratoconus. It is estimated that
almost 21% of keratoconus patients ultimately progress to an advanced stage of
disease requiring corneal transplantation surgery to restore corneal architecture
and improve eyesight.
Dr Rajesh Fogla, Senior Consultant, Corneal Surgeon at Apollo Hospitals, Hyderabad,
India, has special interest in Keratoconus & its management. He has been providing
specialized contact lens fitting for keratoconus patients, and also performs deep
anterior lamellar keratoplasty (DALK) surgery. Compared to conventional full
thickness corneal transplantation surgery, DALK surgery has several advantages.
Unlike conventional corneal transplantation surgery wherein a central disc of full
thickness cornea is entirely replaced with donor tissue, in lamellar keratoplasty
the healthy inner layer of the patient’s cornea is retained and not sacrificed.
(this layer called the endothelium is the most vital layer of the cornea responsible
for maintaining the corneal clarity). Only the outer 80 -90% of the cornea is
replaced with healthy donor tissue. The other advantage of lamellar keratoplasty, is
that as the inner layer is retained, the immune cells of the body do not recognize
the outer donor tissue as being foreign. Hence there is no risk of endothelial
rejection with lamellar keratoplasty, unlike full thickness graft wherein steroid
therapy has to be continued for years to prevent graft rejection episodes. Dr Fogla
has been performing deep anterior lamellar keratoplasty since 1998, and currently
performs the same in all his patients with advanced keratoconus. He has been
conducting instruction courses at various national and international meetings on the
same subject.
Dr Fogla, has started performing collagen crosslinking treatment using the
photo-sensitizer riboflavin (Vitamin B2) and ultraviolet light (365nm) exposure for
keratoconus patients. In extensive experimental studies, researchers have
demonstrated a significant increase in corneal rigidity / stiffness after collagen
cross-linking using this riboflavin / UVA treatment. The 3 & 5 year results of
Dresden clinical study in human eyes has shown arrest of progression of keratoconus
in all treated eyes. (Wollensak G. Crosslinking treatment of progressive
keratoconus: New Hope. Current Opinion in Ophthalmology 2006; 17: 356 - 360).
Keratoconus patients now have a new hope, a new treatment modality which can arrest
the disease progression and thereby prevent the need for surgical intervention in
future. Although the procedure does not provide a cure for keratoconus, it certainly
can stop its progression and patients can continue using their glasses or contact
lenses for improved eyesight. Hence attempt should be made to diagnose keratoconus
early enough and stop its progression using collagen crosslinking. Corneal
topography can detect keratoconus much before it can be picked up on a routine eye
examination. Hence this test should therefore be performed in all cases with high
astigmatism ie cylindrical power to detect keratoconus at an early stage. Further
ongoing studies will help establish collagen cross-linking treatment as the primary
modality of keratoconus treatment.
Currently this treatment is available only at select centers all over the world, and
is performed only under an ethics committee or IRB (Institutional Review Board)
approved study protocol. Dr Fogla has initiated a prospective study on collagen
crosslinking at Apollo Hospitals, Hyderabad. If you have keratoconus and desire more
information, or wish to undergo this treatment, write to Dr Fogla at
dr_fogla@yahoo.com or visit www.corneaclinic.com or call +919866076750
Web Site = http://www.corneaclinic.com
Contact Details = Dr Rajesh Fogla MD, FRCS
Senior Corneal Surgeon
Cornea Clinic
Apollo Hospitals, Jubilee Hills, Hyderabad
India 500033
2009
