What is IntraLase Enabled Keratoplasty? Keratoplasty is an operation on the Cornea. The Cornea is the clear dome on the front of the eye, like a watch glass that covers the front of a wristwatch. It is normally clear and transparent (about half a millimeter in thickness) and functions as the window and lens of eye so that light can pass through it and focus on the Retina. Like a camera, the eye has a lens system, the cornea being the major part of that lens system. The light that enters the eye is focused on to the retina, like the film in a camera. The image formed is transmitted to the brain, where it is interpreted as vision, giving us the powerful sense of sight. Now, if the cornea is defective, and by that I mean, irregular or cloudy, then a clear image is not formed on the retina, and vision is poor. We cannot fix many things that go wrong with the eye, but we can fix the cornea. Just like a window that has been damaged, we can swap out the window of the eye (the Cornea) and replace it. This was done first in a human in 1906, and has become a common form of treatment for many corneal problems such as Keratoconus, Corneal dystrophies and scars from infection or trauma.

The cornea is usually replaced by removing a small circular disc from the center of cornea using a round blade, called a trephine. The new cornea is cut similarly and sewn in place using microscopic stitches. While this is a very good operation, restoring vision to thousands of people every year, it does have its problems. It is straightforward to sew the cornea in place, it is a different matter to get it to be perfectly round and smooth for optimal vision. The healing time is long, up to a year or more, before the best vision is attained.

Fast forward to the present, where at Yonge Eglinton Laser, in partnership with the Toronto Eye Surgery Centre, we can now do the surgery to replace the cornea using a revolutionary Laser, the IntraLase TM. We are proud to be the first surgeons in Canada to have adopted this great advance. The laser focuses a very concentrated beam of infrared light into the cornea. This causes a microscopic gas bubble to form in the cornea. When the bubbles are close enough together, then they gently separate the tissues. The big advance is that the shape of the cut is totally software controlled. This means an extremely precise cut, exactly where we want to put it. Also, the cut can be customized to suit the situation. For example, we can cut the half millimeter thick cornea so that the edge is shaped like a rabbet joint or a tongue in groove joint, as it done in carpentry. This will increase cut surface area by nine times, resulting in a much stronger bond between the donor cornea and the person’s own cornea. But it doesn’t stop there, the laser puts eight marks on the cornea to aid in alignment of the transplant and this should make the result more predictable and smooth. The end result is a stronger, faster healing cornea, with the potential for a better result.

We can also use the IntraLase to make cuts in the cornea to alter the curvature of the cornea after a transplant to help improve the vision. So, all in all, we have an amazing laser machine, that not only allows us to treat patients to reduce their need for glasses, but can also be used to make incisions in the cornea in a very precise and accurate way to improve the results after corneal surgery. Truly science fiction comes true!