Procedures We Offer
The right procedure depends entirely on the condition being treated, the layers of the cornea involved, and the individual guest's anatomy and goals. The following represents the range of corneal surgical and procedural care available at Boling Vision Center.
Phototherapeutic Keratectomy (PTK)
PTK uses an excimer laser to precisely remove diseased, scarred, or irregular tissue from the anterior corneal surface. It's most appropriate for superficial corneal dystrophies, recurrent corneal erosion syndrome, and anterior corneal scarring that is affecting vision or causing chronic discomfort.
Because PTK targets only the outermost corneal layers, it is among the least invasive corneal procedures available and typically involves a relatively straightforward recovery. For the right candidate, it can produce significant improvements in both visual clarity and surface comfort without the need for transplantation.
Corneal Cross-Linking
Corneal cross-linking is the only treatment that addresses the underlying progression of keratoconus and other ectatic corneal conditions rather than simply managing their effects. Using riboflavin eye drops and controlled ultraviolet light, cross-linking strengthens the collagen bonds within the corneal stroma, stabilizing the cornea and halting or significantly slowing its continued weakening and bulging.
Cross-linking is most effective when performed early, before significant corneal thinning or steepening has occurred. It doesn't reverse existing distortion but can prevent the need for more invasive intervention later, making it one of the most impactful treatment decisions a younger guest with progressive keratoconus can make.
Intracorneal Ring Segments
Intracorneal ring segments are small, arc-shaped implants placed within the corneal stroma to help regularize the cone in keratoconus and similar ectatic conditions. By redistributing the corneal curvature, they can improve unaided vision, make contact lens fitting more manageable, and in some cases delay or eliminate the need for corneal transplantation.
They are an option for guests who are no longer achieving adequate vision with specialty lenses alone but who are not yet at the stage where transplantation is required.
Deep Anterior Lamellar Keratoplasty (DALK)
DALK is a partial-thickness corneal transplant technique that replaces the diseased anterior corneal layers while preserving the guest's own healthy endothelium, the innermost layer of the cornea. Because the host endothelium is retained, the risk of endothelial rejection, the most common and serious form of graft rejection, is eliminated.
DALK is the preferred transplant technique for keratoconus and anterior corneal scarring in guests with healthy endothelial function. Recovery takes longer than with surface procedures, but long-term outcomes are excellent, and the preserved endothelium means the graft is more durable over a lifetime.
Descemet's Membrane Endothelial Keratoplasty (DMEK)
DMEK is a highly precise endothelial transplant technique in which only the diseased Descemet's membrane and endothelium are replaced, leaving the majority of the host cornea intact. It is the preferred approach for conditions affecting primarily the endothelium, including Fuchs' endothelial dystrophy and bullous keratopathy.
Because so little host tissue is disturbed, DMEK offers faster visual recovery and lower rejection rates than older full-thickness transplant methods. It requires a high level of surgical expertise, and Boling Vision Center's team is experienced in this advanced technique.
Penetrating Keratoplasty (PKP)
Full-thickness corneal transplantation, or penetrating keratoplasty, remains an important option for guests with corneal disease affecting all layers of the cornea, or in cases where partial-thickness techniques are not appropriate. While recovery is longer and the rejection risk is higher than with lamellar techniques, PKP continues to offer excellent long-term outcomes for the right candidates, and modern surgical refinements have improved both the procedure and the recovery experience significantly.
Amniotic Membrane Transplantation
The amniotic membrane has potent anti-inflammatory and healing-promoting properties that make it a valuable tool in corneal and ocular surface surgery. It can be used as a biological bandage to support the healing of persistent epithelial defects, severe chemical injuries, and other conditions involving significant ocular surface breakdown. In some formulations, it can also be applied in an office setting as a self-retained treatment without the need for surgical placement.
Conjunctival and Limbal Procedures
For guests with limbal stem cell deficiency, pterygium, or other conditions affecting the conjunctiva and limbal region, surgical procedures to restore the ocular surface architecture may be part of the treatment plan. These procedures aim to re-establish the healthy cell populations needed for ongoing corneal surface maintenance.
