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SILK Surgery - Risks and Benefits

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SILK surgery is an innovative eye procedure designed to manage corneal diseases. Read the article to know more.

Medically reviewed by

Dr. Aditi Dubey

Published At June 11, 2024
Reviewed AtJune 11, 2024

Introduction:

SILK (selective intra-lymphatic keratoplasty) is a surgical innovation in ophthalmology. It is used to manage several eye diseases, such as keratoconus (corneal diseases leading to vision loss). Several traditional approaches are used to manage corneal diseases, which involve replacing the corneal thickness, causing complications, graft rejection, and prolonged recovery times.

SILK surgery is a minimally invasive surgical technique that focuses on transplanting corneal layers, preserving the patient's normal cornea. The procedure involves laser technology that excises the damaged corneal tissue, allowing for the insertion of donor tissue with high accuracy. The benefits include quicker recovery and reduced risk of complications. It reduces the disruption of the surrounding healthy tissues and maintains the overall structure of the cornea. The article discusses SILK surgery, its procedure, indications, contraindications, risks, and benefits.

What Is SILK Surgery?

SILK surgery is an incision-less, sutureless, and minimally invasive surgical procedure designed in the field of ophthalmology to reshape the cornea. It is also used to manage other eye diseases, including myopia (nearsightedness), hyperopia (farsightedness), and astigmatism (eye cornea curvature affecting vision). Johnson and Johnson developed the procedure to correct vision. The surgical procedure aims to reduce the need for contact lenses.

Procedure: The key steps involved in SILK surgery are as follows:

1. Pre-Operative Preparation: The pre-operative steps are as follows:

  • Comprehensive Eye Examination: The healthcare provider will assess the eye's health. The doctor may measure refractive error, corneal thickness, and corneal curvature using optical coherence tomography (OCT) and corneal topographers.

  • Patient Assessment: The healthcare provider may evaluate the patient's condition by asking patient's medical history and suitability for SILK surgery. The eye specialist may also discuss the risks and benefits associated with the procedure with the patient.

  • Anesthesia: The eye specialist will apply local anesthetic eye drops to numb the eye, provide comfort during the procedure, and ensure a painless treatment.

2. Surgical Procedure: The detailed description of the SILK surgical procedure is as follows:

  • Laser Application: The healthcare provider will ask the patient to lie comfortably. The patient is positioned under a femtosecond laser. The laser creates a small, lens-shaped corneal tissue called a lenticule within the cornea. The laser separates the lenticule from the surrounding corneal tissue without requiring large incisions and sutures.

  • Creating an Incision: The healthcare provider may create a tiny, tunnel-like incision, typically two to four millimeters (mm), on the surface of the cornea. The eye specialist may use a femtosecond laser to create the small incision, which is used to access the lenticule within the cornea.

  • Lenticule Removal: The healthcare provider may use specialized instruments or micro-surgical instruments to separate or remove the lenticule from within the corneal layers. The separation and removal are done by inserting the specialized instruments through the access incision. The lenticule removal reshapes the cornea and corrects the refractive errors.

  • Corneal Reshaping: After the lenticule is removed, the cornea's shape changes, which alters or changes the focusing power. The small incision allows the cornea to heal naturally without suturing.

3. Postoperative Care: The whole SILK procedure takes about 15 minutes to complete. However, the recovery time is different for everyone. The person can resume their normal activities within a few days. The postoperative instructions are as follows:

  • Immediate Aftercare: The healthcare provider will monitor the patient after the procedure's completion to ensure no immediate complications. The eye specialist may provide protective eye shields to prevent accidental rubbing or unnecessary pressure on the eyes.

  • Medications: The healthcare provider may prescribe antibiotics or anti-inflammatory eye drops to prevent infections and reduce inflammation. The doctor may advise the patient to maintain eye hygiene.

  • Follow-Up Visits: The healthcare provider may schedule follow-up appointments to monitor the healing process and assess visual acuity. Regular eye check-ups are done to ensure the cornea is healing properly and to check for concerns.

What Are the Indications and Contraindications of SILK Surgery?

The indications and contraindications of SILK surgery are as follows:

Indications:

  • Myopia: The procedure is suitable for patients with mild to moderate myopia and advisable for those who prefer a minimally invasive procedure.

  • Hyperopia: The SILK surgery procedure is effective in correcting mild hyperopia. It is also advisable for those looking for alternatives to other refractive surgeries.

  • Astigmatism: It is suitable for patients with astigmatism.

  • Thin Cornea: During the SILK procedure, there is no need to create a thin corneal flap; patients with thinner corneas may benefit from this procedure.

  • Contact Lens Intolerance: This procedure is suitable for patients who are allergic to contact lenses, and want to correct vision and seek a permanent solution. It is also suitable for people experiencing discomfort or complications from long-term contact lens use.

  • People Who Wants to Remove Glasses: People who wants to remove or reduce their dependency on eyeglasses or improve visual acuity can undergo this procedure.

Contraindications:

  • A patient with severe myopia, hypermetropia, or astigmatism.

  • People with eye conditions, such as keratoconus (disease affecting corneal structure) or severe corneal scarring.

  • Severe dry eye syndrome (the eye disease in which the eye does not produce enough ears for lubrication).

  • Patients with autoimmune diseases that affect healing or increase the risk of infection.

  • Hormonal changes during pregnancy and breastfeeding can affect vision stability. It is generally recommended to wait until hormonal changes stabilize.

  • Patients whose refractive error has not been stable for at least one year.

  • Presence of active ocular infections or inflammation.

  • Patients with certain types of previous refractive surgeries may need to be more suitable candidates.

What Are the Benefits of SILK Surgery?

The benefits of SILK surgery are as follows:

  • It is a minimally invasive procedure with a small tunnel-like incision. The small incision naturally heals itself. There is no need for sutures and reducing the risk of associated complications.

  • Many patients may experience improved vision within a day or two after the procedure.

  • The patient feels less postoperative discomfort than with traditional methods.

  • The incidence of dry eye syndrome is reduced as compared to LASIK.

  • The procedure involves minimal removal of corneal tissue, preserving corneal integrity and strength.

  • Improved quality of vision.

  • Reduced risk of postoperative inflammation.

  • Faster healing time.

  • A patient can resume normal activities within a few days.

What Are the Side Effects of SILK Surgery?

The side effects of SILK surgery are as follows:

  • Temporary dryness.

  • Discomfort or mild pain.

  • Vision fluctuation in the initial period.

  • Small risk of infection.

  • Redness, swelling, or irritation of the eye.

  • Cloudy or hazy appearance in the cornea.

  • Visual regression.

Conclusion:

In conclusion, SILK surgery is minimally invasive and an alternative to traditional procedures, such as LASIK. The laser is used to reshape the cornea. The benefits include rapid recovery, precision, safety, and suitability for many patients. The side effects include dry eyes, mild pain, visual regression, and swelling. The patient should ask about the benefits and risks of the procedure before going for the procedure.

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Dr. Aditi Dubey
Dr. Aditi Dubey

Ophthalmology (Eye Care)

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corneal diseasesilk surgery
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