CORNEA - C3R, Keratoplasty

Recognised centre for Corneal transplants & treatment of corneal diseases

What is Cornea?

The Cornea is the transparent, outermost dome shaped part of the eye through which light enters the pupil and is focused on the retina. It is an extremely delicate structure,which requires normal functioning for accurate vision. Diseases and injuries of the cornea can permanently damage it, leading to severe vision loss. At Vision Plus Eye Centre we understand the importance of maintaining a healthy cornea and have an experienced team of Cornea Specialists backed by the latest diagnostic machines to give you the best cornea treatment in Noida & Delhi NCR. We treat all types of complex corneal disorders by both medical and surgical methods.

Understanding the Structure of the Cornea

  • Normal cornea is 11.5mm in diameter & 520-540um thick.
  • Functions such as positive meniscus lens- provides 2/3rd of the eye’s focussing power and hence we can correct refractive errors by changing its shape.
  • Does not have blood vessels, gets oxygen and nutrients from the tear film outside and aqueous humour inside.
  • Rich nerve supply which is highly pain sensitive

5 Layers of the Cornea

Epithelium Layer
The outermost layer which is about 50u in thickness and is made up of 6 to 8 layers of rapidly regenerating cells. It protects the eye from infection and foreign bodies and also absorbs nutrients and oxygen from the tear film which adheres to its shape. It is pain sensitive as it has a rich nerve supply If damaged (Corneal Abrasion) it heals by itself.

Bowman’s Layer
A tough layer of collagen that acts as protective. It can scar if injured.

Stroma Layer
Forms 90% thickness of the cornea. It is made of 78% water and 16% collagen fibrils that are arranged to give clarity. The stroma is reshaped during LASIK surgery. Adequate thickness of the stroma is essential for the normal strength and form. The keratocytes help in repairing if damaged.

Descemet’s membrane
Thin but strong layer of collagen which protects the eye and can regenerate after injury

Endothelium Layer
The innermost layer which is responsible for pumping out fluid and keeping the cornea transparent. A very low endothelial cell count can cause swelling and loss of vision. If damaged by injury, surgery or disease, Endothelial cells cannot regenerate.

Common Corneal disorders.

KERATOCONUS

Keratoconus is a degenerative disease of the cornea in which the cornea progressively becomes thinner and bulges out. It is derived from the Greek word meaning conical cornea. Due to the cone shape there is irregular astigmatism and poor vision quality. It usually begins between 10-25 years or age affecting both eyes though it may be asymmetric with one eye getting affected first. In advanced cases there is scarring and severely compromised vision.

  • Blurred vision
  • Ghosting of images
  • Frequent change of glasses number
  • Light sensitivity and glare
  • Discomfort with glasses
  • Blurred vision
  • Ghosting of images
  • Frequent change of glasses number
  • Light sensitivity and glare
  • Discomfort with glasses

What are the treatment options for keratoconus.

These can help correct vision in the early stages

These can help correct vision in the early stages

CORNEAL EDEMA

The Cornea is the transparent dome shaped outer layer of the eye that helps to focus light onto the Retina. In order to function optimally the cornea must be clear. When the cornea gets swollen due to excess fluid within its layers, the condition is called Corneal Edema. It results in decreased and cloudy vision.

What are the causes?

The innermost layer called the Endothelium acts like a pump to remove excess fluid from within the cornea and thus ensure it remains transparent. Any condition that affects the functioning of the endothelium can result in corneal edema.

  • Cataract surgery
  • Fuch’s Endothelial Dystrophy- more in females, above 50 years
  • Viral Endotheliitis- Herpes virus
  • Contact lens overuse/ sleeping with lenses on
  • Inflammation of the cornea- due to Rheumatoid arthritis, keratitis
  • Preservatives like Benzalkonium
  • Drugs- Dorzolamide

How can it be treated?

  • Cloudy vision especially on waking up
  • Decreased vision
  • Painful blisters
  • Foreign body sensation
  • Colour halos around lights

What are the Symptoms?

  • Medications like saline drops to draw out the fluid from the cornea
  • Steroid drops to reduce the inflammation
  • Bandage contact lenses to reduce the pain from the blisters
  • Antivirals
  • Endothelial Keratoplasty- Replacing the diseased endothelium with a donor graft
  • Penetrating Keratoplasty- Transplanting the entire cornea with a donor cornea

CORNEAL TRANSPLANT SURGERY/ KERATOPLASTY

The Cornea is an extremely delicate structure. Disease or injury can cause permanent damage, scarring and impair its functioning. Blindness due to corneal disease is the 4th most common cause of global blindness. Replacement of the diseased or opaque cornea by a part or whole of a healthy donor cornea is called Corneal Transplantation or Keratoplasty. When a deceased person’s eyes are donated, the eye bank preserves the cornea such that it remains vital. The donated cornea which is transplanted to the recipients eyes is called Corneal graft.

Vision Plus Eye Centre is registered with NOTTO (National Organ & Tissue Transplant Organisation) and our cornea specialists are well experienced in all types of Cornea transplant surgery.

Indications for Cornea Transplant surgery

  • Corneal scar/ opacity significantly affecting vision
  • Keratoconus or thinning of the cornea
  • Hereditary corneal dystrophy
  • Bullous keratopathy after eye surgery
  • Corneal infection not responding to medical therapy

Types of Cornea Transplant surgery

  • Penetration Keratoplasty(PK) – Full thickness of the cornea is replaced. A trephine is used to remove a button of the damaged cornea and an appropriate size of donor cornea is then stitched in place. There is risk of corneal rejection and graft failure. Long term use of medications are required to prevent this.
  • Deep Anterior Lamellar Keratoplasty (DALK) – The anterior diseased layers are replaced by donor tissue leaving behind the healthy endothelium of the recipient.
  • Endothelial Keratoplasty (DSAEK /DMEK) – Only the damaged endothelium which is the thin innermost layer is replaced by the donor tissue. This has lesser chances of rejection and early recovery

Cost of Cornea transplant surgery in Delhi/NCR?

Vision Plus Eye Centre is one of the most affordable eye hospitals for surgery. Our Cornea specialists are highly experienced and give personalised support as cornea transplant surgery requires regular check up. After thorough evaluation, our expert doctors will recommend type of cornea transplant surgery and give the most reasonable estimate

PTERYGIUM

A pterygium is an abnormal growth of fibrovascular tissue from the conjunctiva onto the cornea. It grows slowly and causes a scar which can affect your vision. It may get repeatedly inflamed causing redness of the eyes,irritation and watering. If the pterygium is small it can be ignored but if it is fleshy and extends towards the centre of the cornea, it must be surgically removed. At Vision Plus Eye Centre we do Pterygium surgery with conjunctival autograft using sutureless technique. This has much better results and faster recovery. *pic * surgical video* testimonial

OCULAR HERPES

Herpes virus can affect the eyes causing serious infection of the cornea. There are 2 types of Herpes virus- Herpes simplex and Herpes varicella zoster. If detected and treated timely, complications like corneal scar can be reduced. Treatment is by antiviral drugs. Since virus infections can be recurrent, sometimes long term oral antiviral therapy is advised.

CORNEAL INFECTION / ULCER

The cornea,being the outermost layer of the eye, is at risk of injury by foreign bodies, vegetable matter,chemicals or dirt. Contact lens users, diabetics and indiscriminate use of steroids are at greater risk. If the epithelium which normally protects the eye gets breached, infection can enter the cornea leading to Keratitis or Corneal ulcer. This is an emergency as it can lead to permanent loss of vision. Corneal ulcer can be due to bacteria, virus, fungus or other microorganisms. The common symptoms are redness, watering, purulent discharge, pain, swelling of the lids and impaired vision. It must be treated urgently with frequent eye drops and close follow up. To identify the causative microorganism a corneal scraping is done and sent to the Lab for testing and culture. In very advanced cases not responding to medical treatment corneal transplant surgery may be essential to save the eye.