Cornea

Dr Pooja Bandivadekar

Cornea Diseases and Solutions

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Corneal Transplant

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  • Also called as keratoplasty
  • Replacement of diseased cornea with healthy donor cornea
  • Restores vision as well as some cosmesis

Pterygium Surgery

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  • Pterygium is a fleshy mass growing onto the cornea
  • It induces astigmatism and can vision drop
  • Sutureless Surgical treatment is now available for same

Corneal Ulcer

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  • Specific targeted Medical therapy for corneal infection
  • Corneal transplants for refractory cases

Pediatric Ocular Allergy/ VKC

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  • Treatment of severe eye itching and allergy in children
  • Now being managed with steroid-sparing topical medications

Ocular Surface Tumour

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  • Now eye drops are available to treat some ocular tumours
  • Chemo-reduction of tumours with no systemic side effects now possible

Corneal and Ocular Surface Problems: A public education initiative

What is Cornea?

Cornea is a transparent covering of the eye that allows the light to pass into your eye and fall onto the retina. This transparent covering is necessary for maintaining a crystal clear vision. Also, it is the layer which is reshaped during LASIK to correct refractive error and remove your spectacle number.

My eye has a white spot. Is my cornea affected?

Probably yes. Cornea, like any other tissue in our body can develop scar. Trauma to the eye, incorrect use of contact lens, systemic immunodeficiency can all cause eventual corneal scar. The cornea scarring looks like a white spot. White spot (Corneal Opacity) may or may not affect vision. If it affects vision, a corneal transplantation or Keratoplasty may be performed to restore vision. Rarely white spot may be due to other reasons. To know more contact Cornea specialists at Doctor Eye Institute.

What is corneal transplantation?

In patients with central corneal diseases, the cornea of another person (donor) is transplanted onto the diseased or white cornea to restore vision. Corneal transplantation is the most successful type of transplantation in human body. With advent of newer technology, it is now possible to have sutureless transplantation with very good success rates. Doctor Eye Institute specializes in component corneal transplant i.e only the diseased part of your cornea is specifically replaced by experienced doctors using advanced equipment and highly specialized technique. This not only speeds up the recovery but also decreases the risk of graft rejection (a major cause of graft failure). Doctor eye institute has been officially certified for carrying out corneal transplants under the Human Organ Transplant Act (HOTA).

What are the other options available to patients with white spot on cornea?

Sometimes a patient may not be suitable for transplantation or may desire only cosmetic improvement. In such patients corneal tattooing can be carried out as a semi-permanent way of cosmetic rehabilitation. In some patients, a specialized cosmetic contact lens can be used to hide the white spot improving one’s appearance drastically.
My child has frequent changes in his glass number. Can his cornea be affected?
There are many reasons for frequent changes in glass power in children and young adults. Keratoconus is one of them. It is a progressive disease of cornea characterized by excessive bending or ectasia. Frequent changes in glass number especially cylindrical number/ astigmatism is one of the first signs. If your child suffers from same contact us at Doctor Eye Institute for a screening check-up today. It is now possible to halt keratoconus progression by CXL treatment in select patients. Alternatively, customized contact lens, INTACS and keratoplasty are available for patients in various stages of keratoconus.

How can I help?

Cornea is a living tissue which can be donated by a deceased donor. So pledge your own and your loved ones eyes today. Help someone see the glorious world again

Common corneal problems are: Infections:

Which needs appropriate treatment under Doctor’s guidance. One should not selftreat by taking eyedrops from medical stores. This can cause devastating complications.

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Corneal foreign body:

This is very common problem in this industrial area where we daily see many patients with corneal foreign body. This needs to be removed by expert doctors under Antibiotic drops cover. If not treated properly it can lead to major eye complication.

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Corneal Injury: Will need corneal suturing.

Keratoconus :

Keratoconus is a degenerative disorder of the eye in which structural changes within the cornea cause it to thin and change to a more conical shape than its normal gradual curve.It is typically diagnosed in the patient’s adolescent years and attains its most severe state in the twenties and thirties. A more definitive diagnosis can be obtained by Topography, but Pachymetry and Anterior OCT also are helpful in confirming diagnosis. The Topographical map indicates any distortions or scarring in the cornea, with keratoconus revealed by a characteristic steepening of curvature inferiorly.Topography can record progression of disease.

Treatment include trial of Contact lens, but latest treatment for keratoconus is C3R -Corneal Collagen Crosslinking with Riboflavin. This is a painless, out-patient procedure. It involves absorbing riboflavin eye-drops into the cornea and then bathing the surface of the eye in a very specific wavelength of light. First corneal epithelial layer is removed in order to increase penetration of the riboflavin into the stroma,then riboflavin solution is administered to the eye and is activated by illumination with UV-A light for approximately 30 minutes. The whole process takes about one-and-a-half hours. After the procedure, a protective soft contact lens is worn for about 24 hours, and eye drops need to be instilled as adviced.

The riboflavin causes new bonds to form across adjacent collagen strands in the stromal layer of the cornea, which recovers and preserves some of the cornea’s mechanical strength. This makes the cornea more rigid and can stop the keratoconus from progressing. The treatment may even cause the keratoconus to reverse to some extent, which is analysed by Topographic analysis . The procedure is extremely safe, and no sight-damaging complications have been reported. The earlier the treatment is done, the better, but C3-R can still be beneficial decades after keratoconus has begun to develop.

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CONJUNCTIVA

Pterygium :

pterygium is a triangular-shaped conjunctival tissue growth on the cornea. Some pterygia grow slowly while some more fast.

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Pterygia are more common in sunny climates in age group of 30-40 years in people who spend significant time outdoors probably due to exposure to UV light. Usually people want to get it removed for cosmetic reasons. If the pterygium grows towards the middle of the cornea, it should be surgically removed. They often become sore, red, and gritty, especially with wind, smoke or dust. Eventually the pterygium may interfere with the vision either by distorting the cornea or by extending over the pupil.

The comfort of a pterygium may be improved by using eye drops such as artificial tears. Some pterygia, which continue to cause problems, may require surgical removal.

In surgery( Pterygium excision with conjunctiaval Autgraft ) the pterygium is removed and a small piece of the conjunctiva is placed into this site from under the upper lid. The surgery is performed under local anaesthetic.There is no pain during the surgery, which takes approximately half an hour. Following the procedure eye drops and analgesic tablets are prescribed.Water, dust or dirt in the eye should be avoided for two weeks.

One of the main problems with the removal of a pterygium is that re-growth may occur, although this happens in fewer than 1% with newer surgical techniques. To reduce the risk of recurrence, you should try to reduce exposure to ultra-violet light following surgery by wearing sunglasses. Recurence rate is less if performed by expert surgeons and is more in young patients.