Introduction

Cornea is a transparent dome shaped outer surface that covers the front of the eye like the watch glass. Its transparency is of utmost importance to enable the eye to see clearly. The cornea services at Krishna Eye Centre have specialists trained and skilled in advanced medical and surgical care of patients with cornea and external eye diseases. An individualized treatment plan based on latest and best therapies is given to our patients. Our centre has programs for patients in whom the cornea has become opaque due to scarring. These are corneal transplants of, penetrating and lamellar type, stem cell transplantation, ocular surface reconstruction with amniotic membrane and mucosal membrane. State-of-art surgical techniques make best use of the precious eyes received from the eye bank. The centre prides itself to have faculty that has pioneered Keratoprosthesis surgery like MOOKP (tooth in eye surgery) in Maharashtra for bilateral corneal blindness.

Other conditions handled by the cornea services are Pterygium surgery with suture less conjunctival auto grafts with glue, Red eye management and a tailored Dry Eye programme

Advanced techniques for Keratoconus (conical cornea) treatment like Collagen Cross Linking, Intacs, Phakic lenses and Rose K lenses are offered based on patient’s stage of disease.

Procedures

Penetrating Keratoplasty

Penetrating-KeratoplastyThis is quintessentially a corneal transplant wherein the patient’s faulty or damaged cornea is substituted for a donor’s one. Here, the donor tissue is first prepped and made ready, before the damaged cornea is trephined and removed. The donor tissue is moved into place and then sutured carefully. The sutures are gradually removed as the incision heals.

amellar Keratoplasty

Deep anterior lamellar keratoplasty (DALK)

Lamellar-KeratoplastyNewer method of corneal surgical procedure for removing the corneal stroma down to Descemet’s membrane. It is most useful for the treatment of corneal disease in the setting of a normally functioning endothelium (innermost layer of the cornea). As the inner layer is retained the body does not recognize the donor tissue, hence there is no risk of rejection, and steroid medications need not be continued for a long duration.

Descemet’s Stripping Endothelial Keratoplasty (DSEK)

Descemet's Stripping Endothelial KeratoplastyThis involves surgical replacement of only the damaged inner layers of the cornea. Rather than replacing the full thickness of the cornea, it replaces just the endothelial cells and Descemet’s membrane. the back layer of the cornea is removed through a small incision on the surface of the eye and replaced with a thin layer of the donor tissue. The rest of the cornea is still healthy and is left intact. It less invasive procedure than a standard corneal transplant so recovery is shorter, just a few months as opposed to a year. Vision improvement is evident within weeks. No suturing is necessary, and this reduces risk.

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Ocular Surface Reconstruction

Amniotic membrane transplantation

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Amniotic membrane is the innermost membrane lining the amniotic cavity.Amnion and chorion join to form the fetal membrane by the end of the first trimester of pregnancy.

Amniotic membrane can be used as a graft (inlay), patch (overlay) or in multiple layers. If stored at -80°C it should first be warmed up to room temperature in conditions like Persistent Epithelial Defects and Neurotrophic Ulcers, Shield Ulcers, Infectious Keratitis, Band Keratopathy, Chemical Burns, Bullous Keratopathy, Photorefractive and Phototherapeutic Keratectomy, Conjunctival Surface Reconstruction, Pterygium, Partial Limbal Stem Cell Deficiency (LSCD)

Modified Osteo-Odonto Keratoprosthesis-MOOKP

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We perform a whole range of Corneal Treatment procedures in order to combat a wide range of ailments and issues. These include, but are not limited to:Corneal-Transplant This is a complex operation which involves first excising all the damaged ocular tissue from the eye, before promptly transplanting the inner mucosal lining of the cheek onto the eye’s surface. A canine or premolar tooth with some bone is then promptly extracted and a bolt-shaped appendage is carved from the tooth-bone structure and fitted with a plastic optical cylinder. The tooth-bone-cylinder amalgamation is then implanted within the patients cheek for it to grow a new blood supply system. After about 4 months, the cheek lining over the eye is perforated and the tooth-bone-cylinder device is inserted into the eye. The lining is then closed. Light can now enter the eye through the plastic cylinder, and vision should, ordinarily, be restored.

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Pterygium surgeries

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A pterygium is active mass tissue on the surface of the eye that grows over the front of the cornea (the clear window at the front of the eye). A pterygium usually grows very slowly, over many years. It is more common in people who have been exposed to a lot of sunlight during their lifetime.

How surgery works: Pterygium surgery can be performed under local anaesthesia (awake).

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Limbal Stem Cell transplant

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The origin of the corneal epithelium appears to reside in the cryptsf Vogt, where a population of “immortal” stem cells resides, and possessing enormous potential for clonogenic cell division. These cells, like all stem cells, have inherent properties which enable them to accomplish error-free replication which avoids development of abnormal differentiation and cellular dysfunction.

The absence or malfunction of corneal stem cells is characterized by the loss of proliferative capacity of corneal epithelium, resulting in surfacing of the cornea with “transdifferentiated” conjunctivally-derived epithelium or, in the worst case, failure to resurface at all in the presence of a persistent epithelial defect, with corneal neovascularization and scarring. Such disorders include primary dysfunctions such as aniridia and congenital erythrokeratoderma, and secondary ones (the most common, in which limbal stem cells are destroyed, either traumatically (e.g., alkali burns) or immunologically (e.g., Stevens Johnson syndrome). It is well recognized that simply replacing the cornea through corneal transplantation in these circumstances is almost uniformly unsuccessful. Limbal stem cell grafting has changed all that, but we should emphasize here that, unless the underlying primary problem has been corrected (for example, the constant assault onto the ocular surface from external aggravants, such as sicca syndrome, meibomian gland dysfunction, lagophthalmos, trichiasis, distichiasis, and the “sandpapering” effect of the keratinizated posterior lid margin), limbal stem cell grafting will not be the panacea for such disorders either. However, if one can correct those underlying saboteurs, then limbal stem cell grafting may set the stage for the ultimate visual rehabilitation step (i.e., keratoplasty), once the ocular surface has been re-established with normal, corneally-derived epithelium.

Corneal Collagen Cross linking

Corneal collagen cross-linking is a technique which uses UV light and a photosensitizer to strengthen chemical bonds in the cornea, thus enhancing the rigidity of corneal tissue and stabilizing the condition. Very helpful in condition of Corneal Ectasia.

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