CORNEAL SERVICES AND SURGERIES
The Cornea is the eye’s clear, protective outer layer. Along with the sclera (the white of the eye), it serves as a barrier against dirt, germs, and other things that can cause damage. The cornea also filters out some amounts of the sun’s ultraviolet light.
THE MOST COMMON CORNEAL DISORDERS ARE
- Corneal ulcer and Keratitis –an inflammatory or infective condition of the cornea involving disruption of its epithelial layer with involvement of the corneal stroma. Keratitis is the inflammation of the cornea
- Corneal Foreign body- one of the most common preventable occupational hazards
- Corneal abrasion – a medical condition involving the loss of the surface epithelial layer of the eye’s cornea as a result of trauma to the surface of the eye.
- Keratoconus – an eye disease that affects the structure of the cornea, resulting in loss of vision. With Keratoconus, the clear, dome shaped tissue that covers the eye (cornea) thins and bulges outward into a cone shape.
- Corneal dystrophy / Fuchs’ dystrophy – a condition in which one or more parts of the cornea lose their normal clarity due to a buildup of cloudy material. Fuchs’ dystrophy (Endothelial Corneal Dystrophy) or cloudy vision is the most common dystrophy that is treated in patients.
The Cornea Department at Sri Sankaradeva Nethralaya caters to the efficient diagnosis and management of a wide range of diseases like –
- Congenital and hereditary corneal disorders
- Infectious corneal diseases
- Corneal degenerations and dystrophies, Terrien’s marginal degeneration, Pellucid Marginal degeneration
- Immunologic disorders of the cornea
- Corneal tumors and injuries
- Ocular surface disorders including severe dry eye, blepharitis, ocular allergies, chemical injuries, steven Johnson syndrome and Ocular Surface tumors
In accordance with this, the Investigation and Diagnostics Department at Sri Sankaradeva Nethralaya is well equipped to cater to all the unique and specific requirements of the Cornea Department. The Diagnostics Services relating to corneal disorders that are offered here are:
- Corneal Topography/Tomography – A highly specialized instrument that is the heart of the ocular surface. The Pentacam, based on Scheimpflug photography, is unique in that it provides invaluable information that all other instruments are incapable of measuring.
- Specular Microscopy – A tool to assess the health of corneal endothelial cells.
- Pachymetry – Measurement of corneal thickness
- Anterior segment OCT – Helps identify the depth of corneal scarring/lesions on the cornea, corneal thickness, and anterior chamber details
- Ocular Coherence Tomography (OCT) – To assess corneal health.
- Corneal Photography (Digital Photography) – A digital photographic system of various corneal conditions for baseline documentation, and monitoring effects of therapy as well as to monitor progression of the disease in an ecstatic disorder.
All the diagnostic work carried out by our Cornea Department is complemented by our state-of-the-art Operation Theatres which are well equipped to carry out a wide range of Corneal Procedures. The department offers the most recent advances in the field of corneal surgery which includes:
- PENETRATING KERATOPLASTY – Penetrating Keratoplasty (PK) is a full-thickness, complete transplant of the damaged or diseased cornea with a donor cornea. If a patient suffers poor vision or chronic pain from a corneal condition, disease, or injury, they are likely a good candidate for a corneal transplant.
- DEEP ANTERIOR LAMELLAR KERATOPLASTY (DALK) – DALK is a partial thickness corneal transplant. It is a surgical procedure for treating keratoconus, Fuchs’ dystrophy, and other corneal conditions.
- LAMELLAR CORNEAL SURGERIES OR LAMELLAR KERATOPLASTY – Lamellar keratoplasty is an operation in which diseased layer of cornea is removed and replaced by healthy donor cornea (keratoplasty). The procedure is most useful for the treatment of a normally functioning endothelium, posterior portion of the patient’s cornea (tectonic keratoplasty).
- DEEP ANTERIOR LAMELLAR KERATOPLASTY (DALK) – Deep Anterior Lamellar Keratoplasty (DALK) is a surgical procedure for removing the corneal stroma down to Descemet’s membrane. It is most useful for the treatment of corneal diseases in the setting of a normally functioning endothelium.
- DSEK (Descemet’s Stripping Endothelial Keratoplasty) – Descemet’s Stripping Endothelial Keratoplasty (DSEK) is a corneal transplant technique where the unhealthy, diseased, posterior portion of a patient’s cornea is removed and replaced with healthy donor tissue obtained from the eye bank.
- Patch Graft – Cornea patch graft has been advocated as the surgical procedure to treat a variety of anterior segment pathologies. It involves patching the affected area with full thickness or partial thickness corneal donor tissue.
- CORNEAL COLLAGEN CROSSLINKING (CXL) – Collagen Cross linking for Keratoconus (Accelerated CXL) is a corneal treatment shown to slow the progression of keratoconus where an eye UPA membrane combines with riboflavin to increase the strength of corneal tissue. Crosslinking CXL is the long term to help stabilize vision.
- PTERYGIUM SURGERY – Pterygium surgery involves removal of the abnormal subconjunctival tissue. Development of pterygium is related to long term exposure to UV light and dust. Pterygium may also play a part in the growth of pterygium.
- Pterygium surgery is done once it grows to such an extent that it causes visual problems. Some of the symptoms such as irritation can be addressed with artificial tears. Surgery may also be performed for cosmetic reasons, to remove it, or if it grows quickly. The goal is to remove it completely.
- Conjunctival autograft with tissue glue – Conjunctival auto-grafting is a surgical technique that is an effective and safe procedure for pterygium removal. When the pterygium is removed, the tissue that covers the sclera known as the tenons layer is also removed. Auto-grafting covers the bare sclera with conjunctival tissue removed from the patient’s own eye (usually from the other eye).
- Amniotic Membrane Grafting – Amniotic membrane transplantation is an effective and safe procedure for pterygium removal. Amniotic membrane transplantation is a technique where an amniotic membrane graft is used to repair the defect after pterygium removal. The amniotic membrane is the inner most layer of the human placenta and has been used to replace and heal damaged mucosal surfaces including successful reconstruction of the ocular surface.
- SIMPLE LIMBAL EPITHELIAL TRANSPLANT (SLET) – Simple Limbal Epithelial Transplant (SLET) is a technique for addressing limbal stem cell deficiency.
- OCULAR SURFACE RECONSTRUCTION – Ocular surface disease has emerged as the treatment modality for the eye, namely the cornea and conjunctiva. There are various techniques used to reconstruct the ocular surface.
- Ocular Surface Reconstruction with tissue transplantation has emerged as the treatment modality for ocular surface disorders refractory to conventional medical management.
- AMNIOTIC MEMBRANE TRANSPLANTATION – Amniotic membrane, or amnion, is the innermost layer of the placenta and consists of a thick basement membrane and an avascular stromal matrix. Amniotic membrane transplantation is used to treat chemical burns, extensive pterygium removal and ocular surface disorders.
- CORNEAL TATTOOING – A surgical procedure done in the eye with no visual potential and opacified cornea. Different tattoo inks are available for giving the eye a natural look comparable to the fellow eye.
- MUCOUS MEMBRANE GRAFTING – Mucous membrane graft is a simple and viable option for the ocular surface reconstruction in patients with severe cicatrizing diseases, particularly if they also have Simon’s syndrome and other corneal keratopathy. They have also been used for the reconstruction of the severely contracted socket.
- CORNEAL PATCH GRAFT – A corneal patch graft is a surgical procedure where a corneal patch can aid in the management of small corneal perforations, corneal melts and wound leaks. It may also avoid the need for tectonic penetrating keratoplasty.
- PTK (Photo Therapeutic Keratectomy) – Phototherapeutic Keratectomy (PTK) is an excimer laser surgical procedure that removes roughness or cloudiness from the cornea.
- KERATOPROSTHESIS – Keratoprosthesis is a surgical procedure where a diseased cornea is replaced with an artificial cornea. Traditionally, keratoprosthesis is known as the artificial person has had a failure of one or more donor corneal transplants.
- Boston Keratoprosthesis (KPRO) – A Boston Keratoprosthesis is a device used to replace a diseased cornea with an artificial cornea.
- Auro Keratoprosthesis (Indian)