The Hospital houses a specialized cornea clinic with eye bank facilities.
In this speciality service, we provide quality medical and surgical care to a multitude of corneal problems with utmost care supported by eye bank of international standards and state of art equipment.
Corneal eye disease is the fourth most common cause of blindness (after cataracts, glaucoma and age-related macular degeneration) and affects more than 10 million people worldwide.
Certain conditions can affect the clarity of patient’s cornea and can cause corneal loss of Transparency. These include:
- Scarring from infections, such as viral, fungal or bacterial keratitis.
- Corneal failure due to cataract surgery complications.
- Hereditary conditions such as dystrophy.
- Thinning of the cornea and irregular corneal shape (Keratoconus).
- Chemical burns of the cornea or damage from an eye injury.
- Excessive swelling (edema) of the cornea.
- Graft rejection following a previous corneal transplant.
- Infections of the cornea which worsen in spite of medications.
In these situations corneal transplantation is the only viable option to restore vision and or integrity of the eye.
KERATOPLASTY (CORNEAL TRANSPLANT)
Keratoplasty is a procedure of replacement of unhealthy cornea with a healthy corneal tissue from a donor. The replacement of the cornea can be partial or total thickness depending on the severity of damage to the cornea.
Keratoplasty is performed to restore the function and shape of the cornea while eradicating the damages and deformations of the cornea due to any form of injuries and diseases.
The corneal transplant procedure is among the most common and most successful transplant procedure which has been done for over a hundred years and is usually done on an out-patient basis.
TYPES OF KERATOPLASTY OR CORNEAL TRANSPLANTATION
Optical keratoplasty is a procedure where corneal replacement is done to restore or improve vision.
Optical keratoplasty are of 3 types :
- Penentrating keratoplasty- All the layers of the cornea is changed
- Anterrior Lamellar Keratoplasty(DALK)-Only the front 2/3 portion of the cornea is changed
- Posterior Lamellar Keratoplasty(DSEK)-Only the back 1/3 portion of the cornea is changed
Therapeutic keratoplasty is aimed at restoring the damages in the cornea and is also recommended in inhibiting the progression of the disorder affecting the cornea either partly or fully.
Cosmetic keratoplasty is done to improve the cosmesis. Ugly cloudy cornea is replaced with clean transparent cornea.
CORNEAL COLLAGEN CROSS-LINKING (CCL) IN THE MANAGEMENT OF KERATOCONUS
It is a revolutionary treatment option for progressive Keratoconus.
Keratoconus is a bilateral ocular disorder in which the cornea assumes a conical shape due to thinning of the stromal collagen tissue.It is a relatively frequent disease with an incidence of 1 in 2000 in the general population.It classically has its onset at puberty and is progressive until
the third or fourth decade of life when it usually arrests.
Keratoconus can be detected clinically by slit lamp examination and the diagnosis can be confirmed by corneal topography.
Currently, the mainstay of treatment for Keratoconus include glasses and/or specially designed rigid gas permeable contact lenses which offer good quality of vision. In advance cases keratoconus can be corrected surgically by corneal grafting and placement of intracorneal rings.
However, all these treatment options only correct the refractory error in Keratoconus and do not address the issue of progression of the disease.
Collagen Cross Linking is a new modality of treatment that aims to arrest progression of keratoconus.
What is Collagen cross-linking?
The corneal collagen is cross-linked with the help of ultraviolet rays ( UVA ) and a photo
sensitiser, Riboflavin , thus enhancing the rigidity of corneal tissue and stabilizing the condition.
Who is a suitable candidate for Collagen cross-linking ?
- Patient must be a proven case of keratoconus with documented progression
of the disease.
- Patient’s corneal thickness must be at least 400 microns with epithelium off.
- Patient should not be pregnant or nursing.
How is cross-linking performed ?
The treatment is performed under topical anesthesia with the patient in a lying down posture in the sterile environment of the operating room. The patient’s corneal epithelium is gently removed, following which Riboflavin solution is applied every 2 minutes for the first 30 minutes. Thereafter the patient’s cornea is exposed to UV light for half an hour in conventional method or 10 minutes in accelerated CXL. The treatment is painless and lasts for an hour, at the end of which bandage soft contact lens is placed.
When can the patient resume normal routine?
After the treatment, patient will be able to resume work within 3 to 4 days.
Care should be taken to avoid entry of water into the eyes during this period. The use of contact lenses may be resumed 6 weeks after treatment.
How often must the patient come for follow up ?
The surgeon will examine the patient’s eye for the first post op day and on fourth day until the epithelial healing is complete. Eye drops will be used for 3 months. Patient will have to come for follow up at 6 weeks, 3 months, 6 months, 1 year and 2 years after the procedure.
Can both eyes be treated at the same time?
If both eyes are suitable for Collagen cross-linking, the treatment is performed on one eye at a time .The timing of treatment of the second eye is best decided by the consultant.
What are the possible side effects of the procedure?
A foreign body sensation, irritation or watering accompanied by pain is not uncommon on the day of treatment. Analgesics for relief from pain will be prescribed, and the pain usually subsides within 24 hours.
Dryness of the eyes frequently follows this treatment and may last for 6
to 8 months. Tear lubricants are therefore recommended for the period.
Concerns using UV light
UV light can potentially harm the vital cell layer of the cornea known as the endothelium as also the crystalline lens and the retina. However, the use of riboflavin and the choice of the wavelength of UV light used, substantially reduces the intraocular penetration of UV rays to negligible levels. Potential side effects are therefore avoided. It is mandatory to perform a preoperative measurement of the corneal thickness.
Keratoprosthesis, the transplantation of an artificial cornea, was first performed in Italy by Benedetto Strampelli the 1960s .
Patients requiring repeat corneal transplantation or the results of transplant surgery is not good, in such patients the need for an alternative procedure is required & that is keratoprosthesis .
Keratoprosthesis surgery is a procedure of last-resort, reserved for patients who are not candidates for keratoplasty or corneal transplantation.The visual results are excellent if the retina & optic nerve are normal.
K-Pro placement offers relatively fast visual rehabilitation. The devices are amenable for use in many situations in which other types of keratoplasty are not an option.
Other procedures offered at our center
- Special contact lens like Rose K & Boston C.L. for Keratoconus
- Ocular surface reconstruction for eyes damaged by chemical or thermal injury with Stem cell transplantation (autologous, cultured as well as SLET) Amniotic membrane transplantation
- Pterygium surgery with autograft and glue
- Dry eye assessment and management
- Ocular surface neoplasia – diagnosis and management
- Corneal and adnexal infections – microbiological diagnosis and treatment
- Surgical management of corneal ulcers – therapeutic corneal grafts, tectonic grafts
- Corneal tattooing for cosmesis in disfigured corneas
- Prior appointment not required. You can walk in to seek solution for your corneal problems and or to take second opinion. Old records (eye & medical) are helpful in diagnosis and management.
- CLINICAL TESTS : After the initial examination you may require special tests to ascertain the health of cornea structurally and functionally. A detailed report of the same would be handed over.