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Australian-first keratoconus surgery performed in Brisbane

Dr David Gunn QEI CAIRS keratoconus

 

The first corneal allogenic intrastromal ring segment (CAIRS) surgery in Australia has been performed at the Queensland Eye Institute (QEI), paving the way to better sight for keratoconus patients.

Ophthalmologist Dr David Gunn recently conducted the procedure that overcomes higher complications rates associated with current synthetic corneal implants by using donor tissue instead.

“We are so happy to be able to bring this innovative new treatment option to Australia,” Gunn – a cornea, cataract, laser and refractive specialist – said.

The ring segments are dissected from the cornea after being prepared by a laser.

“CAIRS surgery is a major step towards opening up more treatment options for keratoconus with other procedures, rather than a full corneal graft with its invasiveness and higher risks. It can mean the end of reliance on hard contact lenses for some patients.”

According to Gunn, corneal cross-linking treatment can stabilise keratoconus, but it generally doesn’t improve vision. Glasses can improve vision but become no longer useful later in the disease process, giving way to hard contact lens use. Approximately 20% of patients will need a full corneal graft to regain sight.

He said corneal implants could improve the shape of the cornea without removing tissue.

The current approach involves plastic corneal implants – known as synthetic intrastromal ring segments – which are effective but have higher complication rates. These include erosion of the implant to the surface of the eye and corneal melt or infection with many implants lasting only five to 10 years before removal.Now, CAIRS surgery replaces the plastic with a ring of donor corneal tissue. Gunn said this brought improved safety and longevity due to better biocompatibility and lower risk of infection. It can have a greater effect due to more superficial placement and can be used in patients with more severe disease.

A spatula is used to enter into the laser channels in the cornea to prepare them for implantation of the CAIRS implant.

According to QEI, the procedure takes approximately 30 minutes and patients notice significant improvements to their vision within a month, with positive change likely to continue and remain permanent.

The novel technique was developed by Dr Soosan Jacob, from Dr Agarwal’s Eye Hospital and Research Center in India.

In an interview with the American Academy of Ophthalmology in 2017, she discussed the process of extracting the CAIRS segment from donor tissue, and how she performed the technique.

Keratoconus affects one in every 84 Australians aged in their 20s.

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