Category Archives: Ectasia

PROSE Lenses – Pellucid Marginal Degeneration (PMD)

Pellucid Marginal Degeneration:

Pellucid Marginal Degeneration is a sub-category of Keratoconus. Pellucid corneas involve a larger distorted geographic area usually extending from the inferior corneal margins up to the center of the cornea. It is not unusual for 50% or more of the corneal surface to be involved. Because so much of the cornea can be affected, fitting this type of cornea can be challenging. The problem we face as eye care practitioners is fitting the steep areas if the cornea without adversely affecting the flatter areas.

PVR PROSE Lenses | GPVR PROSE Treatment:

PVR PROSE- Precision Vision Rehabilitation  Prosthetic Replacement of the Ocular Surface Ecosystem

Our PVR PROSE Treatment is a process that uses a prosthetic device, like a scleral lens, to replace the ocular surface to provide functional vision to complex corneal conditions. Utilizing our knowledge, experience, and technology, like the Vistante- Optical Coherence Tomography OCT, we are able to customize a prosthetic PROSE lens, with the precise measurements down to the micron. With an exact fit, there is proper movement, comfort, and perfect vision.

PROSE Lenses are large-diameter gas permeable contact lenses specially designed to vault the entire corneal surface and rest on the “white” of the eye (sclera). In doing so, PROSE scleral lenses functionally replace the irregular cornea with a perfectly smooth optical surface to correct vision problems caused by, keratoconus, Lasik failures, post-surgical complications, and other corneal irregularities.

Because PROSE Lenses / scleral lenses are designed to vault the corneal surface and rest on the less sensitive surface of the sclera, these lenses often are more comfortable for a person with corneal irregularities caused by keratoconus and other corneal irregularities A special liquid fills the space between the back surface of the lens and the front surface of the cornea. This liquid acts as a buffer and protects the compromised corneal tissue. Scleral lenses are designed to fit with little or no lens movement during blinks, making them more stable on the eye, compared with traditional corneal gas permeable lenses. These lenses are almost always very comfortable and the vision provided by them is extremely good. The great majority of patients are able to wear their scleral lenses almost all of their waking hours without problems.

Dr. Irwin Azman, Keratoconus Specialists in Maryland, prescribes PVR PROSE Lenses for a variety of hard-to-fit eyes, including patients with Stevens-Johnson Syndrome, Radial Keratotomy and Lasik Complications and Lasik failures, keratoconus, Corneal Ectasia, Post-Surgical Vision Loss, and Pellucid Marginal Degeneration.

Dr. Irwin Azman specializes in keratoconus, LASIK failures and other corneal irregularities neither avoids nor declines the challenge of prescribing the most difficult cases.

PVR PROSE Lenses for Post LASIK Side Effects

PVR PROSE Lenses are helpful in a lot of post LASIK complications and side effects including corneal ectasia, irregular astigmatism, dry eyes, etc.

PVR PROSE Lenses don’t come in contact with the cornea of the eye, therefore they’re helpful in patients having sensitive or irregular cornea, where soft and conventional contact lenses can’t be used.

There is a film of tear between the PVR PROSE Lens and the cornea, which provides a cushion as well as helps in uniform refraction while the light rays pass through the lens, cornea and the gap in between.

PVR PROSE Lens for post Lasik ectasia

PVR PROSE Lenses and dry eyes

PVR PROSE Lenses and nearsightedness or farsightedness

PVR PROSE Lenses and irregular astigmatism

PVR PROSE Lenses can be helpful in patients suffering with irregular astigmatism after the LASIK procedure.

If you’re having any complications after LASIK procedure consult our specialist to discuss the post Lasik side effects in your case and the best possible treatment options for you.

Post Lasik Ectasia

Post Lasik ectasia of the cornea is one of the most severe complications of Lasik (Laser in situ Keratomileusis).

The Lasik procedure permanently weakens and thins out the cornea, resulting in progressive changes in the cornea such as steepening or bulging, called ectasia. Corneal ectasia results in the visual deterioration.

Keratoconus vs Ectasia

Keratoconus and post Lasik ectasia (keratectasia) are histologically two different processes. Keratoconus is a corneal disorder that isn’t related to surgery and affects both eyes. It begins usually in late teenage years or around puberty. Keratectasia is a result of corneal manipulation during surgery, like Lasik. If the patient didn’t have keratoconus before surgery and didn’t have any family history of the disease, then the post Lasik weakening of the cornea is probably keratectasia (ectasia).

Risk factors of Post Lasik Ectasia

Most common risk factors of post Lasik Ectasia in order of significance are:

  • Abnormal preoperative topography
  • Low residual stromal bed (RSB) thickness
  • Young age
  • Low perioperative corneal thickness
  • High myopia

Post Lasik Ectasia

Treatment of Post Lasik Ectasia

Treatment options for post Lasik ectasia include:

Contact lenses

Contact lenses are helpful in the rehabilitation of vision in patients with post Lasik ectasia. The types of contact lenses best for the patient can be variable as per the exact symptoms and case along with patient’s personal preference. Some of the options include:

  • Rigid gas permeable contact lenses (RGP)
  • Scleral contact lenses
  • Soft contact lenses (custom wavefront guided)
  • Hybrid contact lenses
  • Tandem soft contact lenses

Preferably scleral lenses and rigid gas permeable contact lenses are chosen for the patients. However if they are intolerant to the rigid gas permeable lenses they can be advised the tandem soft contact lenses, hybrid contact lenses and the scleral contact lenses as the next options.

Intracorneal ring segments

Intracorneal ring segments (ICRS) are used in post Lasik ectasia patients having thin cornea that can’t tolerate the contact lens. The size, symmetry, location and number of segments to use are dependent on the individual case and surgeon’s decision.

Corneal collagen cross-linking

The anterior thin layer of cornea is weakened during the flap creation. Most of the cross linking effect occurs in that almost 200 microns of anterior layer of cornea. Cross linking has been claimed to stop the progress of ectasia therefore corneal collagen cross-linking (CXL) can be used to stop post Lasik ectasia from getting worse.

Combination therapies

Some patients might need and benefit from the combination therapies including intracorneal ring segments or corneal crosslinking or any other combined therapy.

Penetrating keratoplasty

Penetrating keratoplasty (PKP) is used as the last resort in patients with post Lasik estasia.

Global Complex Eye Care was specifically designed, equipped, and staffed to provide patients with nothing but the finest in professional eye care. As Post LASIK specialists, we have successfully treated patients with Post Lasik Ectasia, Keratoconus, LASIK Dry Eye and other side effects, Pellucid Marginal Degeneration, Stevens-Johnson Syndrome, and other irregular corneas. Optometrists and Ophthalmologists from all over Maryland and surrounding states refer patients to Dr. Irwin Azman.

For more information please call, (240) 782-2020
to schedule your complimentary telephone consultation.