Cornea Clinic

In India, corneal diseases rank third among causes of blindness or low vision, covering a range of issues like pterygium, corneal tears, and infective keratitis. Managing these conditions requires specialised care tailored to each individual's needs.

Pterygium

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Pterygium is a thin, veil-like growth typically found on the exposed area of the eye's white surface. It gradually extends over the cornea, the central black portion of the eye, potentially obstructing vision or causing a decline in vision quality by inducing astigmatism.

Symptoms of pterygium may include:

• Burning
• Gritty feeling
• Itching
• Sensation of a foreign body in the eye
• Blurred vision

Causes of Pterygium : significant risk factors include:

• Prolonged exposure to ultraviolet light
• Dry eye
• Irritants such as dust and wind

Treatment of Pterygium

Pterygium is not only cosmetically disfiguring but can affect the vision also. In view of this it is advisable to surgically excise it at the earliest. Surgical excision of pterygium is a simple day care procedure with no adverse effects.

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Latest surgery method involves removing the pterygium tissue and placing a healthy tissue on the bare area which prevents recurrence and is cosmetically very rewarding.

Surgery for pterygium is minimally invasive, sutureless and is very safe.

Pterygium does not respond to medical treatment of any kind be it in form of eye drops or ointment and surgical excision is the treatment of choice

Keratoconus Treatment In Mumbai

Keratoconus is a condition that affects the outer transparent layer of the eye, known as the cornea, typically occurring in young adults, often in their twenties. It involves the progressive thinning of the cornea, causing it to bulge forward and adopt a cone-like shape. This irregularity in the cornea leads to the formation of a distorted image of objects on the retina, resulting in blurred vision.

Symptoms & signs of Keratoconus

• Keratoconus causes myopia or nearsightedness & astigmatism.
• Frequent change in glasses prescription with fluctuation in vision.
• Glare & sensitivity to light especially during night.
• In the advanced stage of Keratoconus, corrective prescription glasses do not help patients to see clearly & they have to switch to using hard or semi-soft contact lenses.
• Keratoconus can be diagnosed at an early stage with detailed eye examination which includes Retinoscopy,
• Slit lamp examination & sophisticated tests like Topography to check the shape & curvature of cornea & Pachymetry to determine the thickness of the cornea.

Causes

• Exact causes of Keratoconus is not known but latest research suggests that the cornea becomes weakened due to an imbalance of enzymes within the corneal tissue. Young patients produce high levels of free radicals which cause oxidative damage to the cornea in absence of protective enzymes causing thinning & bulging of the cornea.

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• Keratoconus also shows some genetic predisposition. It may transmit from parent to children & affect more than one family member. It is also associated with excessive rubbing as it is more common in allergic conjunctivitis patients who have itching & tend to rub their eyes more frequently.

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• Other risk factors are overexposure to ultraviolet rays, chronic eye irritation & improperly fitting contact lenses.

Treatment Options  

In early stages, when the cornea is still regular, corrective prescription glasses or soft contact lenses can help the patient. As keratoconus advances, the corneal surface becomes increasingly irregular & these options do not help adequately. 

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In the intermediate & advanced stage, various other treatment options & different types of contact lenses are available.

• Rigid Gas permeable contact lenses: provide a smooth refractive surface replacing the irregular cone like surface of the cornea, thus enabling the patient to see clearly. Lens fitting in Keratoconus can be a demanding & time consuming process. RGP lenses are not as comfortable as soft contact lenses.
• Piggybacking Contact Lenses: a soft contact lens is first placed on cornea to give it a cushion like effect & RGP lens is fitted over it. Best features of both lenses are combined – makes the wearer comfortable & at the same time gives crisp & clear vision. The fitting should be perfect to ensure good oxygen permeability to the cornea as the patient will be wearing two lenses. However, with newer high oxygen permeable lenses this is not a problem.
• Hybrid Contact lenses: uniquely designed wherein the central visual portion is made up of high oxygen permeable rigid material & peripheral anchoring portion is of soft hydrogel material. Maximises the best features of both lenses & improves wearers comfort as well as visual performance in keratoconic eyes.

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New Vistas In Surgical Treatment Of Keratoconus :Intacs (Intra Corneal Ring Segments)

Patients experiencing moderate, non-progressive keratoconus and are unable to tolerate contact lenses may benefit from INTACS. This procedure not only enhances visual outcomes but also decreases reliance on glasses or contact lenses. INTACS consist of inert material rings implanted in the mid-periphery of the cornea. They effectively flatten the curvature of the keratoconic cornea, resulting in improved vision.

Benefits

• Simple 10 minute outpatient procedure
• Marked improvement in vision
• Removable & exchangeable
• Minimally invasive as compared to corneal transplantation
• Delays the progression of keratoconus

C3 – R (CORNEAL COLLAGEN CROSSLINKING)

Corneal collagen crosslinking with riboflavin represents a recent advancement in treating early progressive keratoconus. This minimally invasive procedure, performed as a day care treatment, works to stabilise the condition and prevent further deterioration of vision. Utilising modern corneal topography equipment, early detection of keratoconus is facilitated, allowing for timely intervention with C3R to halt its progression and minimise visual impairment. C3R is considered a safe and effective procedure for managing early progressive keratoconus.

Penetrating Keratoplasty

This involves full thickness corneal transplantation, where the entire recipient cornea is replaced with full thickness donor cornea. This type of penetrating surgery is usually indicated for full thickness corneal opacity, failed grafts and macular corneal dystrophy. This type of surgery gives very good visual outcomes but has a long recovery period.

DALK (Deep anterior lamellar Keratoplasty)

This represents a recent modification of keratoplasty, where full-thickness transplantation is not required. Instead, only the top three layers of the diseased cornea are replaced with healthy donor tissue. This approach results in a quicker recovery period, minimal risk of rejection, and improved visual outcomes. It is recommended for cases of advanced keratoconus or superficial scarring.

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Keratoplasty (Corneal Transplantation)

What is ‘Corneal Transplantation’?

Corneal transplantation, also known as keratoplasty or corneal grafting, is a surgical procedure that aims to restore sight in individuals afflicted with corneal blindness. During this procedure, the diseased and opaque cornea is replaced with a clear, healthy donor corneal tissue. This restores vision by allowing light rays to enter the eye through the transplanted clear cornea. Corneal grafting relies on the availability of donor corneas, typically obtained through the process of eye donation. By donating their eyes after death, individuals can provide the precious gift of sight to those who are visually impaired, offering them invaluable opportunities for improved quality of life.

Who can donate eyes?

Eye donation is a possibility only after death, and individuals of any age, gender, caste, or religion, including those who wear glasses or have undergone eye surgery, can donate. People from any age group can pledge to donate their eyes after death. Even if one has not made a pledge themselves, their relatives can consent to the donation of their eyes after their passing.

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Eye tissue procurement typically occurs within six hours of death. Families can proceed with funeral arrangements without delay or interruption. Every effort is made to preserve the donor's appearance, and their body is treated with utmost respect at all times. Funeral arrangements, including viewing if desired, can proceed as planned.

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Precautions after pledging eyes of deceased:

Here are the steps to follow for eye donation:

1. Switch off fans and, if available, switch on the air conditioner.
2. Raise the head of the deceased slightly by placing a pillow underneath.
3. Place a wet, clean cloth over the closed eyelids, ensuring they are properly closed.
4. Keep a copy of the death certificate ready, if available.
5. Contact the nearest eye bank as quickly as possible.
6. Provide the correct address with specific landmarks or well-known names of the area, along with mobile and residence numbers, to enable the eye bank team to locate the house easily.
7. Provide alternate cell numbers of any available relatives.
8. The eye bank team, consisting of a trained technician and/or a registered medical practitioner, will arrive to remove the eyes after obtaining consent on a printed form in the presence of two witnesses.
9. A small quantity of blood sample will be drawn to rule out communicable diseases.

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Different Techniques of Keratoplasty Penetrating keratoplasty (Corneal Transplantation):

This procedure involves full-thickness corneal transplantation, where the entire recipient cornea is replaced with a full-thickness donor cornea. This type of penetrating surgery is typically indicated for cases of full-thickness corneal opacity, failed grafts, and macular corneal dystrophy. While this surgery can result in excellent visual outcomes, it does require a long recovery period.

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DALK (Deep anterior lamellar Keratoplasty)

This is a recent modification of keratoplasty where full-thickness transplantation is not performed. Instead, this procedure involves replacing only the top three diseased layers of the cornea with healthy donor tissue. This approach results in a faster recovery period, minimal risk of rejection, and better visual outcomes. It is particularly indicated for cases with advanced keratoconus and superficial scars.

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DSEK (Descemet's stripping endothelial keratoplasty)

DSEK (Descemet's Stripping Endothelial Keratoplasty) is the latest addition to the treatment options for endothelial disease of the cornea. This keratoplasty modification involves replacing the diseased Descemet's membrane and endothelium with healthy donor endothelium, Descemet's membrane, and posterior stroma. The procedure is sutureless, offering several advantages such as faster recovery, better visual outcomes, and a reduced risk of suture-related infections.

Descemet’s Membrane Endothelial Keratoplasty (DMEK)

Descemet membrane endothelial keratoplasty (DMEK) is the most recent solution to treat the decreased vision due to corneal oedema seen in Fuchs dystrophy, bullous keratopathy, and other causes of poor corneal endothelial function. There are three generations in the evolution of corneal transplantation and DMEK is the third and latest.

In DMEK the diseased innermost layer of the cornea is removed surgically and the corresponding thin layer from a healthy donor cornea is put in its place. The thin delicate transplant is secured with only an air bubble. The surgery can be combined with cataract surgery for patients who require both.

DMEK provides quick improvement in vision with reduced risk of rejection making it keratoplasty of choice in patients with corneal oedema.

Benefits of DMEK

• 2.8 mm or smaller corneal incision
• No increase in corneal thickness
• Quick visual recovery so patients can resume daily activities early
• Better visual outcomes compared to other keratoplasty methods
• Reduced risk of vision threatening graft rejection episodes

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Understanding Keratoconus with Dr. Niteen Dedhia | Keratoconus specialist in Mumbai, India

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Are you looking for Cornea or Keratoconus Treatment in Mumbai City?

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If you are looking for Cornea Surgery or Keratoconus Treatment in Mumbai City, Surya Eye Hospital is here to assist. Surya Eye Hospital can help with your Cornea Surgery or Keratoconus Treatment.

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Contact Surya Eye Hospital today for all your cornea surgery or keratoconus treatment needs in Mumbai City. Call us at +91 8070504504

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