Chad Rostron: Experience

Corneal Transplantation

My interest in corneal grafting was first aroused when as a Senior House officer I worked for a gifted corneal surgeon Mr Charles Kanagasundaram. He performed beautiful penetrating grafts as well as interesting corneal inlays, which was fairly unique at the time.

As a Senior Registrar, I was fascinated by the discovery of epikeratophakia, and went out to New Orleans to learn the technique from Herb Kaufman. Although at that time epikeratophakia lenticules were available in the USA, I was unable to obtain them in the UK, so developed a new system to manufacture them by dry-state lathing.

On my appointment as Consultant at St George's Hospital, I was fortunate to be able to establish the Keratec Eye Bank in the Department of Anatomy with the help of Professor Noel Dilly. In the eye bank we were able to produce freeze-died lenticules which could be used not only for epikeratophakia, but also for lamellar keratoplasty. During the 1990s my clinical research efforts use focussed on developing improved methods of carrying out anterior lamellar keratoplasty. In conjunction with other corneal surgeons from around the world, this work has now resulted in a widespread acceptance of the benefits of Deep Anterior Lamellar Keratoplasty (DALK) over penetrating grafts for many indications.

Clinical studies in both the UK, and overseas, have shown that DALK carried out with freeze-dried tissue is not only effective, but free from problems of graft rejection. As such the technique is of particular importance in situations where the post-operative follow-up and treatment is difficult. Over the past few years I have given training courses, lectured, and carried out demonstration DALK surgery in many countries.

My current clinical research involves a number of studies of new keratoplasty techniques. These include participation in the nationwide multi-centre prospective study into tissue-matching in high risk grafts. At St George's I am studying the use of tissue adhesive in Descemet's Stripping Endothelial Lamellar Keratoplasty, and the use of freeze-died keratophakia lenticules, and Intacs, in corneal ectasia.

Refractive Surgery Experience

My interest and involvement in refractive surgery dates back to before the days of excimer lasers. My early experiences included radial keratotomy (RK) and astigmatic keratotomy for treating myopia and myopic astigmatism, and epikeratophakia and hydrogel keratophakia for treatment of hypermetropia.

When excimer lasers became available in the early 1990s I learnt to do photorefractive keratectomy (PRK) on the Nidek and VISX laser platforms.

In 1995, excimer laser in situ keratomileusis (LASIK) was introduced into the UK, and I was one of the first ophthalmologists to use the technique here. At that time I was working with the Technolas Keracor 116 laser, and treating both myopia and low hypermetropia by LASIK. With increasing demand for LASIK surgeons, I undertook a 'Train the Trainers' course in Chicago in October 1996, and became a qualified teacher of LASIK. Since then I have trained many ophthalmologists to be laser refractive surgeons, and have helped set up a number of new laser surgery centres around the UK. Over the years I have had training for, and experience of, a number of different excimer laser platforms, including Nidek, Technolas 116 / 117 / 217A, VISX Star S2 / S3, and Autonomous LADARVision 4000.

I have worked in Accuvision Laser Eye Centre since 2002, shortly after it opened, and have been its Medical Director since October 2003. During my time at Accuvision I have used both the Wavelight ALLEGRETTO WAVE 200Hz, and more recently the Eye-Q 400Hz model. Currently the team at Accuvision offer a full range of excimer laser treatment modalities including standard wave-front optimised LASIK, as well as wave-front guided, topography guided, and 'F-CAT''Q-value' adjusted treatments.

In addition to my corneal refractive surgical techniques, I have had training and experience with a variety of intra-ocular refractive surgery procedures, such as clear lens extraction with spherical or toric intra-ocular lens implantation, and phakic intra-ocular lens implantation with Staar Implantable Contact Lens® (ICL), and with Ophtec Artisan and Artiflex phakic lens implants.

I continue to be involved in teaching and research at the forefront of the field of kerato-refractive surgery.