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Doctor in Dayal Eye Centre
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Eye Check-Up
Treatment of Squint
Cataract Surgery
Laser Treatment
Lasik Surgery Treatment
Vertigo Treatment
Routine Eye Checkup
Vitreo-Retinal Surgery
Laser Cataract Surgery
Reduced Vision Treatment
Visual Field Testing
Oculoplastic Surgery
Retina And Lasik Surgery
Refractive Surgery
Endoscopic Dcr Procedure
Eye Muscle Surgeries
Otoplasty Surgery
Blepharoplasty Procedure
Corneal Surgery
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Ulcers and perforations of cornea are some very serious clinical conditions, which threaten vision rapidly and progressively, and disintegrate the eye globe. They need to be taken care of immediately to prevent irreparable damage to the eyes. In spite of the advanced medical research and practice, severe injuries, infections, and diseases of cornea can lead to serious corneal perforations, which require surgery necessarily as the ultimate solution.
Urgent reconstructive surgery might be necessary to avoid consecutive endophthalmitis, formation of synechiae (anterior and posterior), and secondary glaucoma to prevent spread of pathogens toward posterior pole of eye globe. This surgery is also performed to avoid other severe complications including inflammation.
The approach of performing surgery to retain corneal integrity depends on localization, size, state of internal globe tissue, and depth and severity of corneal tissue damage. The state of inflammation and causative infection influences the choice and sequence of surgeries. Urgent Penetrating Keratoplasty, Total Penetrating Keratoplasty, and Corneal or Corneo Scleral Patch Graft, or combination of surgical approaches, also called ‘Keratoprosthesis’, which are performed only for end-stage, progressive corneal pathology, or the last-chance medical treatment.
Ramon Castroviejo, in 1951, described Penetrating Keratoplasty as a method to replace a larger diseased cornea and sclera lying adjacent to it with donor tissue.
The goal of Penetrating Keratoplasty is tectonic repair of large corneal perforations to restore the integrity of the eye globe and correcting or resolving many other conditions of the eye simultaneously.
When to Perform Penetrating Keratoplasty?
Penetrating Keratoplasty is performed for perforated cornea in the following cases:
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Corneal degenerations.
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Keratoconus and ectasias.
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Corneal dystrophies including Fuchs endothelial dystrophy.
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Viral keratitis.
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Noninfectious ulcerative keratitis.
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Post infectious keratitis.
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Microbial keratitis including Fungal and Bacterial keratitis.
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Chemical injuries.
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Congenital opacities.
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Refractive indications.
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Mechanical trauma.
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Regraft unrelated to allograft rejection.
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Regraft related to allograft rejection.
Surgical Procedure:
Surgical procedure involves the following steps:
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Preparation of donor tissue is the first step. A corneal button slightly larger than the host corneal opening helps in reducing post-surgical excessive corneal flattening, reducing risk of secondary glaucoma, and enhancing closure of wound.
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Afterwards, host cornea is trephined; viscoelastic is filled into the anterior chamber followed by placement of donor tissue on the endothelial side down of recipient's eye.
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Cornea is then sutured in place, interruptedly or continuously. Interrupted sutures are preferred in inflamed, vascularized, or thinned corneas and in paediatric cases.
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Penetrating Keratoplasty might be performed in combination with cataract surgery, glaucoma surgery, retinal surgery. and secondary intraocular lens implantation.
Take Away:
Penetrating Keratoplasty is the true and last-chance medical treatment to treat large corneal perforations. It is the only ophthalmologic surgical procedure which restores ocular integrity, and at the same time takes care of infections, inflammations, and necrotic tissue. Such a holistic approach minimizes the risk of endophthalmitis and prevents the spread of disease to the globe of the eye. It also improves the probability of graft survival and has a good potential to improve visual acuity.
Penetrating Keratoplasty is an effective surgical process. However, it is always advisable to consult an experienced and skilled surgeon before opting for this method.
Amblyopia or Lazy eye is the eye condition in which vision is reduced and cannot be corrected with glasses or contact lenses. All the images seen by the amblyopic eye are not fully acknowledged by the brain. It always affects only one eye, but may be accompanied with reduction of vision in both eyes. It can cause loss of vision, including loss of depth perception and two-eyed 3D vision. It's treatment can yield improvements at any age, but early detection can offer the best chances for a cure. Recent research has proven that lazy eye treatment can be successful in older children and adults. Comprehensive vision examinations are required for infants, toddlers, and pre-school children for the detection of lazy eye or amblyopia.
When the brain parts related with visual processing do not function properly, problems arise with such visual functions as the perception of movement, depth perception and fine detail (acuity, clear eyesight and sharp vision). Amblyopia is the most prevalent neurological defect of vision in children and adults resulting from developmental problems in the brain. Any interference with clear vision in either eye during the first six years or 'critical' period of visual and brain development can cause a lazy eye.
Constant strabismus or the constant turn of one eye in any direction, be it inward turn or crossed eye is one of common causes of amblyopia. The differences in vision or it's prescription between the two eyes leads to refractive amblyopia. Sometimes congenital disorders or a physical blockage of an eye due to trauma, drooping lids, cataract or a blocked tear duct can also lead to amblyopia. Many parents and children are not aware of any symptoms, as amblyopia usually occurs in one eye only and a lazy eye condition can exist without a noticeable eye turn. The visual acuity tests in addition to the 20/20 eye test charts and eye examination with cycloplegic drops by ophthalmologists are necessary to detect lazy eye.
Vision therapy for the eyes and brain is a highly effective non-surgical treatment for lazy eye. It is a progressive program of vision exercises customized to fit the visual needs of each patient. It is conducted at the clinic and occasionally supplemented with exercises to be done at home or workplace. It improve visual comfort, ease, and efficiency and change how a patient processes or interprets visual information. When considering treatment options, it is important to understand that lazy eye results from neurological deficit or problems in the brain and surgery for lazy eye is performed on the muscles on the outside of the eye. Most of the cases, lazy eye surgery provides cosmetic benefits and does not improve the patient's vision, hence options for vision improvement should be exhausted before eye muscle surgery is considered.