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.
Chemical and Mechanical injuries of Cornea
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
Corneal and Scleral infections
Ectatic corneal disorders like Keratoconus, Terriens marginal degeneration, Pellucid Marginal degeneration
Immunologic disorders of the cornea
Peripheral ulcerative keratitis
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 Diagnostic Services relating to corneal disorders that are offered here are:
Corneal Topography (PENTACAM, ORBSCAN, TOPOLYZER) – Evaluates shape and power of the corneal surface. The Pentacam, based on Scheimpflug photography, is unique in that it provides invaluable information that the other instruments are incapable of measuring
Confocal Microscopy – Live microscopic imaging of corneal disorders
Pachymetry – Measurement of corneal thickness
Specular Microscopy – Study of the corneal endothelium (cells that maintain corneal clarity)
Anterior segment OCT – helps identify the depth of corneal scarring/lesions on the cornea, corneal thickness, and anterior chamber details
Tear Osmolarity – Measures tear osmolarity helping detect dry eye
Anterior segment digital photography – Photographic documentation of various corneal conditions for baseline documentation, and monitoring effects of therapy as well as to monitor progression of the disease in any ectatic 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 include:
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. Optical, tectonic and therapeutic with anterior segment reconstruction combined with SFIOL, Vitreo-retinal procedures and Pediatric Penetrating Keratoplasty.
LAMELLAR CORNEAL SURGERIES OR LAMELLAR KERATOPLASTY - Lamellar keratoplasty is an operation in which diseased layer of cornea is removed and replaced by lamellar corneal tissue from a donor. The procedure is performed either to improve vision (optical keratoplasty) or to provide structural support for the 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 / DSAEK – DSEK (Descemet’s Stripping Endothelial Keratoplasty) / DSAEK (Descemet’s Stripping Automated Endothelial Keratoplasty) 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 (C3R) – Collagen Cross linking for Keratoconus (Accelerated C3R) is a corneal treatment shown to slow the progression of Keratoconus where we use UV-A radiation combined with Riboflavin drops to increase the strength of corneal tissue. Undergoing C3R in the early stages may 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. Genetic factors 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 considered for unmanageable symptoms. The two surgeries that can be done for the removal of Pterygium are –
Conjunctival Autograft with Tissue Glue Amniotic Membrane Grafting
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 that is surgically removed from an area of healthy conjunctiva.
Amniotic Membrane Grafting - Amniotic membrane transplantation is an effective and safe procedure for pterygium removal. Amniotic membrane transplantation offers practical alternative to conjunctival auto graft transplantation for extensive pterygium removal. Amniotic membrane transplantation is tissue that is acquired from the innermost 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 TRANSPLANTATION - Simple Limbal Epithelial Transplant (SLET) is a technique for addressing limbal stem cell deficiency.
AUTOSLET - Limbal tissue from a donor eye, typically the patient's fellow healthy eye, is transplanted onto an amniotic membrane attached to the surface of the diseased eye.
ALLOSLET – in case both eyes are affected, Limbal tissue can be obtained from a donor cornea within 48 hours.
OCULAR SURFACE RECONSTRUCTION - Ocular surface disease indicates damage to the surface layers of the eye, namely the cornea and conjunctiva. There are many causes ocular surface disease, but the 2 most common ones are “dry eye syndrome” and “blepharitis”. Ocular Surface Reconstruction with tissue transplantation has emerged as the treatment modality for ocular surface disorders refractory to conventional medical therapies.
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 TATTOO – It is a cosmetic 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 disorders like thermal injury. Steven Johnson’s syndrome and ocular cicratricial pemphigold. They have also been used for the reconstruction of the severely contracted socket.
Cynoacrylate Glue + BCL - The effective early application of a cyanoacrylate glue 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 Ketatomy) - 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 recommended after person has had a failure of two or more donor corneal transplants.
Boston Keratoprosthesis and its variant (Imported) Auro Keratoprosthesis (Indian)
Auro Keratoprosthesis (Indian)
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