CORNEA

The cornea is vital for vision because it focuses light onto the retina. It’s a clear, dome-shaped front part of the eye that protects it and helps keep vision clear. Damage to the cornea can lead to vision problems, highlighting its importance.

Corneal Health and Care

Avoid rubbing your eyes

Wear protective eyewear

Follow a balanced diet

Take breaks from screens

Visit an eye care professional

Follow the rule 20-20-20

Treatments available at Shanthi Nethralaya Eye Hospital

Ocular Surface Disorders

Ectatic Disorders

Keratoconus

A progressive thinning and bulging of the cornea, resulting in distorted vision. It is often treated with specialized contact lenses, corneal cross-linking, or corneal transplant.

Pellucid Marginal Degeneration

Pellucid Marginal Degeneration a thinning of the cornea along its lower edge, causing irregular astigmatism and visual impairment.

Posterior Keratoconus

A thinning of the cornea along its lower edge, causing irregular astigmatism and visual impairment.

Infectious Disorders

Bacterial Keratitis

Viral Keratitis

Fungal Keratitis

Acanthamoeba Keratitis

Corneal Transplants

Indications for Corneal Transplants

Corneal scar

Keratoconus

Fuchs' dystrophy

Corneal degeneration

corneal swelling

Failed previous transplant

Preparation for Corneal Transplants

Before the surgery, patients undergo a thorough evaluation to assess their overall health and suitability for the procedure. Pre-operative tests may include blood tests, imaging, and a complete eye examination. Patients may need to stop certain medications prior to the surgery.

Recovery and Post-Surgery Care

Recovery from corneal transplants can vary depending on the type of procedure and individual patient factors. Patients may experience discomfort and vision fluctuations in the initial days or weeks after surgery. Post-surgery care includes using prescribed eye drops to prevent infection and inflammation, as well as attending follow-up appointments for monitoring progress.

Risks and Complications

Types of Corneal Transplants

Why choose Shanthi Nethralaya Eye Hospital for Corneal Transplants

CORNEA

Introduction

The cornea is the eye's primary focusing element, bending light to help form clear images on the retina. It also acts as a protective barrier against dirt and hazards. Any damage to the cornea can disrupt vision, underscoring its importance for clear sight.

Corneal Health and Care

Daily care and protection of the cornea

The cornea is a vital part of the eye that plays a crucial role in vision. Daily care and protection of the cornea are essential to maintain good eye health. Here are some tips to ensure the well-being of your cornea:

Avoid rubbing your eyes
Wear protective eyewear
Follow a balanced diet
Take breaks from screens
Visit an eye care professional
Follow the rule 20-20-20

Treatments available at Shanthi Nethralaya Eye Hospital

Common corneal disorders can be broadly categorized into ocular surface disorders, ectatic disorders, infectious disorders, and corneal degenerative and dystrophic conditions. Each category encompasses a variety of conditions that can affect the cornea’s health and function, impacting vision and overall eye wellness.

Ocular Surface Disorders

Ectatic Disorders

Pellucid Marginal Degeneration

Pellucid Marginal Degeneration

Pellucid Marginal Degeneration a thinning of the cornea along its lower edge, causing irregular astigmatism and visual impairment.

Infectious Disorders

Corneal Transplants

Indications for Corneal Transplants

Corneal scar
Fuchs' dystrophy
Corneal degeneration
corneal swelling

Failed previous corneal transplant

Preparation for Corneal Transplants

Before the surgery, patients undergo a thorough evaluation to assess their overall health and suitability for the procedure. Pre-operative tests may include blood tests, imaging, and a complete eye examination. Patients may need to stop certain medications prior to the surgery.

Recovery and Post-Surgery Care

Recovery from corneal transplants can vary depending on the type of procedure and individual patient factors. Patients may experience discomfort and vision fluctuations in the initial days or weeks after surgery. Post-surgery care includes using prescribed eye drops to prevent infection and inflammation, as well as attending follow-up appointments for monitoring progress.

Risks and Complications

While corneal transplants are generally safe, potential risks and complications include

Types of Corneal Transplants

Penetrating Keratoplasty (PKP)

  • Overview: Penetrating keratoplasty (PKP) is a full-thickness corneal transplant where the entire cornea is replaced with healthy donor tissue. This is one of the oldest and most common forms of corneal transplant, used to treat conditions such as corneal scarring, dystrophies, and keratoconus.
  • Procedure: The surgeon removes a circular portion of the patient’s damaged cornea and replaces it with a matching circular donor cornea, sewing it in place with sutures. PKP is typically performed under local anesthesia with sedation or general anesthesia.
  • Recovery: Recovery can take several months, as the sutures need time to heal and vision may fluctuate during this period. Regular follow-up appointments are necessary to monitor healing and progress.

Deep Anterior Lamellar Keratoplasty (DALK)

  • Overview:DALK removes the outer layers of the cornea up to Descemet’s membrane, leaving the endothelium intact. This procedure may require specialized equipment and techniques.
  • Procedure:In ALK, the surgeon carefully removes the anterior layers of the cornea and replaces them with donor tissue. The endothelium is left intact, reducing the risk of rejection.
  • Recovery:Recovery from ALK is generally quicker than PKP, as the endothelium is preserved.

Descemet's Stripping Endothelial Keratoplasty (DSEK)

  • Overview: DSEK is similar to DSAEK but uses a thinner donor graft composed of the endothelium, Descemet’s membrane, and a very thin layer of stroma.
  • Procedure: The procedure is similar to DSAEK, but with a thinner graft that allows for better fit and quicker recovery.
  • Recovery: Recovery is generally faster, and patients may experience improved vision within a few weeks.

Descemet's Membrane Endothelial Keratoplasty (DMEK)

  • Overview: DMEK is the most advanced form of endothelial keratoplasty, involving the replacement of only the endothelium and Descemet’s membrane with an ultra-thin donor graft.
  • Procedure: The surgeon removes the patient’s damaged endothelium and Descemet’s membrane and replaces it with the donor graft. Precision and skill are required to handle the delicate tissue.
  • Recovery: Recovery is rapid, and vision can improve significantly within a short period. The risk of rejection is lower than in other transplants.
  •  

These different types of corneal transplants offer various options to address specific corneal issues. The choice of procedure depends on the patient’s condition, the surgeon’s expertise, and the expected outcomes.

Why choose Shanthi Nethralaya Eye Hospital for Corneal Transplants

Shanthi Nethralaya Eye Hospital is a premier choice for corneal transplant surgeries due to the expertise and experience of Dr. Shanthiniketh, who performs these procedures at the hospital. Here are several reasons why patients may choose Shanthi Nethralaya for corneal transplant surgeries

Dr. Shanthi Niketh, Hyderabad cataract and refractive surgeon, performing eye surgery

Surgeon's Expertise

Training at LVPEI: Dr. Shanthiniketh received specialized training at L.V. Prasad Eye Institute (LVPEI), a renowned eye care center known for its excellence in ophthalmology. This training has equipped him with advanced skills and knowledge in corneal surgeries. Extensive Experience: Dr. Shanthiniketh has performed over 1,000 eye transplants throughout his career, demonstrating his proficiency in a wide range of corneal procedures, including advanced lamellar techniques.Continuous Learning: Dr. Shanthiniketh stays updated on the latest advancements in corneal transplant surgeries, ensuring patients receive the most effective and modern care.

Contributions to Eye Care

Development of Cornea Department: Dr. Shanthiniketh has been instrumental in developing the cornea department at Akira Eye Hospital in Rajahmundry, enhancing the quality of eye care in the region. Chief Cornea Consultant: Dr. Shanthiniketh serves as the chief cornea consultant at Neoretina Eye Hospital, part of the Centre for Sight group of hospitals, contributing his expertise to another esteemed institution.

Commitment to Quality Care

Personalized Care: Patients receive individualized treatment plans tailored to their specific needs, from preoperative assessments to postoperative follow-up care. Advanced Surgical Techniques: Shanthi Nethralaya employs cutting-edge techniques such as Descemet's membrane endothelial keratoplasty (DMEK) and Descemet's stripping endothelial keratoplasty (DSEK), ensuring precise and successful procedures. Comprehensive Postoperative Support: The hospital offers thorough postoperative care, including regular follow-up visits and personalized guidance for optimal recovery.

Patient-Centered Approach

Patient Education: Dr. Shanthiniketh prioritizes educating patients about their condition, the surgical process, and postoperative care, empowering them to make informed decisions about their eye health. Comfort and Convenience: Shanthi Nethralaya's facilities are designed to provide a welcoming and supportive environment for patients.

In summary, Shanthi Nethralaya Eye Hospital offers top-notch corneal transplant surgeries with the exceptional expertise of Dr. Shanthiniketh, backed by his training at LVPEI and commitment to personalized, high-quality care. The hospital’s focus on patient education and comprehensive support ensures optimal outcomes and patient satisfaction.

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FAQ'S

What is a corneal transplant?

A corneal transplant, also known as keratoplasty, is a surgical procedure to replace part of your cornea with corneal tissue from a donor. The cornea is the transparent, dome-shaped surface of your eye that accounts for a large part of your eye's focusing power.

What are the types of corneal transplant surgeries?

Penetrating Keratoplasty (PKP): A full-thickness transplant where the entire cornea is replaced. Deep Anterior Lamellar Keratoplasty (DALK): Replaces the front layers of the cornea, leaving the inner endothelial layer intact. Endothelial Keratoplasty (EK): Replaces only the innermost layer of the cornea.This includes Descemet’s Stripping Endothelial Keratoplasty (DSEK) and Descemet Membrane Endothelial Keratoplasty (DMEK).

What is Penetrating Keratoplasty (PKP)?

Penetrating Keratoplasty (PKP) is a full-thickness corneal transplant where the entire cornea is replaced. It is commonly used for conditions where the whole cornea is diseased, such as in advanced keratoconus, corneal scarring, or severe corneal thinning. Deep Anterior Lamellar Keratoplasty (DALK): Replaces the front layers of the cornea, leaving the inner endothelial layer intact. Endothelial Keratoplasty (EK): Replaces only the innermost layer of the cornea.This includes Descemet’s Stripping Endothelial Keratoplasty (DSEK) and Descemet Membrane Endothelial Keratoplasty (DMEK).

What is Deep Anterior Lamellar Keratoplasty (DALK)?

Deep Anterior Lamellar Keratoplasty (DALK) is a partial-thickness corneal transplant that replaces the front layers of the cornea while keeping the healthy endothelial layer. This technique is often used for conditions affecting the corneal stroma but sparing the endothelium, such as keratoconus or corneal dystrophies. Deep Anterior Lamellar Keratoplasty (DALK): Replaces the front layers of the cornea, leaving the inner endothelial layer intact. Endothelial Keratoplasty (EK): Replaces only the innermost layer of the cornea.This includes Descemet’s Stripping Endothelial Keratoplasty (DSEK) and Descemet Membrane Endothelial Keratoplasty (DMEK).

What is Endothelial Keratoplasty (DSEK/DMEK)?

Endothelial Keratoplasty (EK) includes procedures like Descemet’s Stripping Endothelial Keratoplasty (DSEK) and Descemet Membrane Endothelial Keratoplasty (DMEK). These surgeries replace only the damaged endothelial layer of the cornea, which is responsible for pumping fluid out of the cornea to keep it clear. They are commonly used for endothelial dysfunction conditions, such as Fuchs' dystrophy. Deep Anterior Lamellar Keratoplasty (DALK): Replaces the front layers of the cornea, leaving the inner endothelial layer intact. Endothelial Keratoplasty (EK): Replaces only the innermost layer of the cornea.This includes Descemet’s Stripping Endothelial Keratoplasty (DSEK) and Descemet Membrane Endothelial Keratoplasty (DMEK).

How is the donor cornea prepared?

The donor cornea is typically prepared by an eye bank. For PKP, the entire cornea is used. For DALK and EK, the corneal tissue is carefully dissected to isolate the necessary layers. The preparation can be done manually or with the assistance of a femtosecond laser. Deep Anterior Lamellar Keratoplasty (DALK): Replaces the front layers of the cornea, leaving the inner endothelial layer intact. Endothelial Keratoplasty (EK): Replaces only the innermost layer of the cornea.This includes Descemet’s Stripping Endothelial Keratoplasty (DSEK) and Descemet Membrane Endothelial Keratoplasty (DMEK).

What are the risks of corneal transplant surgery?

Risks include: Rejection of the donor cornea Infection Increased intraocular pressure Graft failure Vision problems such as astigmatismDeep Anterior Lamellar Keratoplasty (DALK): Replaces the front layers of the cornea, leaving the inner endothelial layer intact. Endothelial Keratoplasty (EK): Replaces only the innermost layer of the cornea.This includes Descemet’s Stripping Endothelial Keratoplasty (DSEK) and Descemet Membrane Endothelial Keratoplasty (DMEK).

What is the recovery time after a corneal transplant?

Recovery time varies depending on the type of transplant: PKP: Full visual recovery can take up to a year. DALK: Recovery is usually faster than PKP but still takes several months. DSEK/DMEK: Recovery is typically quicker, with significant improvement in vision within a few months.

How successful are corneal transplants?

Success rates are generally high but vary by type: PKP: Success rates around 90% in favorable conditions. DALK: Similar success rates to PKP, with the added benefit of lower rejection risk. DSEK/DMEK: High success rates with quicker recovery and lower rejection risk.PKP: Full visual recovery can take up to a year. DALK: Recovery is usually faster than PKP but still takes several months. DSEK/DMEK: Recovery is typically quicker, with significant improvement in vision within a few months.

What should I expect after surgery?

After surgery, you will need regular follow-up visits to monitor healing and detect any signs of rejection or complications. You may need to use medications such as antibiotics and steroids for several months to prevent infection and reduce inflammation. PKP: Success rates around 90% in favorable conditions. DALK: Similar success rates to PKP, with the added benefit of lower rejection risk. DSEK/DMEK: High success rates with quicker recovery and lower rejection risk.PKP: Full visual recovery can take up to a year. DALK: Recovery is usually faster than PKP but still takes several months. DSEK/DMEK: Recovery is typically quicker, with significant improvement in vision within a few months.

Can I undergo a corneal transplant if I have another eye condition?

Your ophthalmologist will evaluate your overall eye health to determine if a corneal transplant is appropriate. Conditions such as glaucoma or retinal problems may require additional management or could influence the decision and timing of the transplant. PKP: Success rates around 90% in favorable conditions. DALK: Similar success rates to PKP, with the added benefit of lower rejection risk. DSEK/DMEK: High success rates with quicker recovery and lower rejection risk.PKP: Full visual recovery can take up to a year. DALK: Recovery is usually faster than PKP but still takes several months. DSEK/DMEK: Recovery is typically quicker, with significant improvement in vision within a few months.

Indications for Corneal Transplant Surgery

What conditions may require a corneal transplant?

Keratoconus: Progressive thinning and bulging of the cornea. Corneal Scarring: From infections or trauma affecting vision. Fuchs' Dystrophy: Genetic disorder causing endothelial cell loss and corneal swelling. Corneal Dystrophies: Inherited conditions leading to corneal clouding and vision loss. Corneal Edema: Swelling due to endothelial dysfunction. Failed Previous Corneal Transplant: Rejection or failure of a previous graft. Corneal Thinning: Conditions like pellucid marginal degeneration. Severe Corneal Ulcers or Infections: Unresponsive to medical treatment.

Am I a Right Candidate for Surgery?

How do I know if I am a candidate for corneal transplant surgery?

Severity of Corneal Damage: Significant vision impairment. Overall Eye Health: Absence of other eye conditions like uncontrolled glaucoma. General Health: Good overall health and ability to undergo surgery. Previous Treatments: Ineffectiveness of other treatments like contact lenses or medications.

What evaluations are done to determine suitability for a corneal transplant?

Comprehensive Eye Exam: Assessment of corneal damage and eye health. Medical History Review: Check for underlying health conditions. Specialized Tests: Corneal topography and pachymetry for corneal thickness and shape.

Post-Operative Care

What should I expect immediately after corneal transplant surgery?

Eye Patch: Protection for the eye initially. Medications: Antibiotic and steroid drops to prevent infection and inflammation. Follow-up Visits: Regular appointments to monitor healing.

What are the key components of post-operative care?

Medications: Adherence to prescribed eye drops. Activity Restrictions: Avoiding strenuous activities and potential eye irritants. Eye Protection: Wearing protective eyewear to prevent injury. Hygiene: Keeping the eye area clean and not touching or rubbing the eye.

What are the signs of complications or rejection?

Symptoms: Redness, pain, light sensitivity, decreased vision, or a feeling of something in the eye. Immediate Action: Contact your ophthalmologist if symptoms occur.

How long will I need to use medications after surgery?

Duration: Steroid eye drops may be required for at least a year, sometimes for life. Frequency: Initially several times a day, gradually decreasing over time

What is the frequency of follow-up visits after corneal transplant surgery?

Immediate Post-Operative Period: Weekly for the first month. Long-Term Follow-Up: Monthly, then every few months, eventually annual if no complications.

How long is the recovery period?

PKP: Up to a year for full visual recovery. DALK: Several months, typically faster than PKP. DSEK/DMEK: Significant improvement within a few months.

Are there any long-term care considerations?

Regular Check-ups: Lifelong monitoring to ensure graft health. Ongoing Medication: Long-term steroid drops to prevent rejection.
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