Understanding Keratomileusis – A Complete Guide to Corneal Reshaping Surgery

What is Keratomileusis?

Keratomileusis is a surgical procedure designed to correct refractive errors in the eye, including nearsightedness (myopia), farsightedness (hypermetropia), and astigmatism. The term originates from Greek, where “kerato” means cornea, and “mileusis” means carving. This procedure involves reshaping the cornea to improve how light is focused onto the retina, thus enhancing vision without the need for corrective lenses.

Unlike traditional corrective methods such as eyeglasses and contact lenses, keratomileusis offers a long-term solution by permanently altering the cornea’s shape. The introduction of laser technology has significantly refined this procedure, making it safer and more precise.

The History and Evolution of Keratomileusis

The concept of keratomileusis dates back to the 1940s when Dr. José Ignacio Barraquer, a Spanish ophthalmologist, pioneered techniques for corneal reshaping. Initially, the procedure involved manually removing, freezing, reshaping, and reattaching corneal tissue, a complex and time-consuming method.

With technological advancements, particularly in laser technology, keratomileusis evolved into modern refractive surgeries such as LASIK (Laser-Assisted in Situ Keratomileusis), significantly improving accuracy and reducing recovery time. Today, keratomileusis is synonymous with LASIK, which remains one of the most commonly performed vision correction surgeries worldwide.

Different Types of Keratomileusis Procedures

There are several types of keratomileusis procedures, each designed to address specific vision correction needs:

• Automated Lamellar Keratomileusis (ALK): One of the earlier forms, this method involved using a microkeratome (a surgical blade) to create a corneal flap, followed by reshaping the underlying tissue.
• Laser-Assisted in Situ Keratomileusis (LASIK): This modern technique employs a femtosecond laser to create the corneal flap and an excimer laser to reshape the corneal tissue with high precision.
  If you’re considering vision correction, LASIK is typically sought after. Read the transformative benefits of LASIK to know more.
• Epi-LASIK: A variation of LASIK, this procedure involves lifting only the epithelium (the outermost corneal layer) rather than creating a full flap, reducing the risk of flap-related complications.
• Photorefractive Keratectomy (PRK): An alternative to LASIK, PRK removes the corneal epithelium entirely before reshaping the cornea, making it suitable for patients with thinner corneas.
  If you have more queries regarding PRK, read our blog on what PRK is and how you may be eligible for it.

Step-by-Step Process of Keratomileusis Surgery

The keratomileusis procedure typically follows these steps:

1. Pre-Surgical Assessment: A thorough eye examination determines whether the patient is a suitable candidate. Tests assess corneal thickness, refractive errors, and overall eye health.
2. Anaesthesia Administration: Numbing eye drops are applied to ensure the patient does not feel pain during the procedure.
3. Creation of the Corneal Flap: Using either a microkeratome or a femtosecond laser, a thin corneal flap is created and lifted to expose the underlying tissue.
4. Reshaping the Cornea: An excimer laser is used to remove precise amounts of corneal tissue, correcting the refractive error.
5. Repositioning the Flap: The corneal flap is carefully placed back into position, where it adheres naturally without the need for stitches.
6. Post-Surgical Care: The patient receives medicated eye drops and instructions for recovery, including avoiding strenuous activities and rubbing the eyes.

Benefits of Keratomileusis

Keratomileusis provides numerous advantages for individuals seeking vision correction:

• Long-Term Vision Improvement: Most patients achieve lasting results with minimal need for further corrections.
• Minimal Discomfort: The procedure is performed under local anaesthesia, and post-operative pain is generally mild.
• Quick Recovery Time: Many patients experience improved vision within 24 hours, with full stabilisation occurring over a few weeks.
• High Success Rate: With advancements in laser technology, the precision and effectiveness of keratomileusis have greatly improved.

Potential Risks and Complications

Although keratomileusis is a safe and widely performed procedure, there are some associated risks:

• Dry Eyes: Temporary dryness is common but can be managed with lubricating eye drops.
• Halos and Glare: Some patients experience visual disturbances, particularly in low-light conditions.
• Under or Overcorrection: In some cases, an additional enhancement procedure may be required to fine-tune vision.
• Flap Complications: Rare risks include flap dislocation, infection, or irregular healing.

Recovery and Aftercare Following Keratomileusis

Proper post-operative care is crucial for a smooth recovery and optimal visual outcomes. Patients should follow these guidelines:

• Avoid Rubbing the Eyes: Rubbing the eyes can displace the corneal flap and affect healing.
• Use Prescribed Eye Drops: Medications help prevent infections and alleviate dryness.
• Limit Screen Time and Sun Exposure: Reducing screen use and wearing UV-protective sunglasses can aid healing.
• Attend Follow-Up Appointments: Regular check-ups ensure proper healing and detect any early complications.

Comparing Keratomileusis with Other Refractive Surgeries

Keratomileusis is often compared with other refractive procedures. Here’s how it differs:

• LASIK vs. PRK: PRK does not involve a corneal flap but has a longer recovery period.
  To better understand how PRK compares to LASIK, you can explore our detailed guide on what PRK surgery is.
• SMILE vs. Keratomileusis: SMILE is a minimally invasive procedure using a single laser, suitable for myopia and astigmatism.
• Lens Implantation: Unlike keratomileusis, intraocular lens implants are an option for patients with severe refractive errors who are not eligible for laser surgery.

Conclusion

Keratomileusis has revolutionized the field of vision correction, offering patients an effective and long-lasting solution for refractive errors. With modern advancements in laser technology, the procedure has become safer and more accessible. Consulting an experienced ophthalmologist is essential for determining eligibility and ensuring a smooth surgical experience.

Take the first step toward a clear vision with keratomileusis. Schedule your appointment!

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