EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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May 2012 EWInternational 47 did not need keratoplasty, Dr. Swailem said. KKESH performs a remarkable number of keratoplasties, setting an internal record last January at 206 transplants (Wilmer performs only 380 per year by comparison, Dr. Behrens said). Still, Dr. Swailem looks forward to avoiding more keratoplasties when possible. "Lamellar keratoplasty started in Saudi Arabia," Dr. Swailem said. "KKESH doctors are skillful in per- forming deep lamellar keratoplasty. We have good results, but we don't think we need to offer it to moder- ate or mild cases of keratoconus." She advocates for the use of more intrastromal corneal rings instead. Although infection has been cited as an uncommon but still oc- curring complication in some Euro- pean multicenter and FDA studies, KKESH has experienced fewer infec- tions with intrastromal corneal rings. Dr. Swailem cites use of the femtosecond in lessening infection rates. Shallow implantation is un- likely to occur, she said. The shape of the wound also is smoother and the tunnel is tighter (hence no space for accumulation of foreign bodies). "All of this resulted in reducing infection," Dr. Swailem said. Also of benefit: The procedure allows pa- tients to wear glasses again, the cornea becomes more regular in shape, irregular astigmatism is reduced, and the procedure is reversible. Meanwhile, the Wilmer Eye Institute has benefited from its partnership with KKESH and vice versa, Dr. Behrens said. "We never see the amount of keratoconus patients [at Wilmer] that we see here," Dr. Behrens said. "This is something unique. It allows us to do unique research and care for these particular diseases." Contact lenses, for example, have not been widely used in Saudi Arabia for keratoconus patients. "We use a lot of contact lenses in the Western world [for disease treatment]," Dr. Behrens said. "Here it is very difficult because of the dry- ness and the dust. However, we are creating a new service of contact lens teaching here. So we dedicate more time to helping patients learn how to wear them, improve their compliance of treatment, and pre- vent more aggressive treatment." As time goes on, expect to see KKESH publish original research from its findings on keratoconus and new treatments from studies that are currently ongoing. "There is definitely some link- age to keratoconus that is genetic," Dr. Behrens said. "We're trying to detect those factors and genes." EW Editors' note: Drs. Behrens and Swailem have no financial interests related to this article. Contact information Behrens: abehrens@jhmi.edu Swailem: sswailem@kkesh.med.sa