Cornea service at AJEH

The cornea is the clear front dome shaped window of the eye. It provides about 2/3 of the eye's focusing power. It gives us a clear window to look through and is the key to good vision. It also helps shield the rest of the eye from germs, dust, and other harmful pollutants.

The Corneal Service at our centre delivers medical and surgical care to a wide variety of corneal, external eye related diseases and anterior segment eye disorders.

The Service is managed by a trained corneal sub-specialist ophthalmologist.

Some of the problems dealt with are:
1. OCULAR SURFACE DISORDERS: Diseases affecting the ocular surface result in non-specific symptoms and can range from a tired or itching eye to diminished vision in severe cases.

• The common conditions are:
• Dry Eye Disorders
• Corneal diseases with stem-cell deficiency
• Pterygium and other conjunctival disorders
• Ocular sensitivity and Neurotrophic Keratopathy
• Ocular allergic diseases
• Eyelid margin diseases such as Blepharitis and Meibomitis

2. INFECTIONS: Rapid and appropriate management of patients with infections is of paramount importance to minimize visual loss, relieve pain, eliminate the infectious agent, and minimize structural damage to the cornea and the other ocular structures. The common conditions are:

• Conjunctivitis (red eye)
• Corneal ulcers
• Scleral ulcers

3. CORNEAL DYSTROPHIES : Corneal dystrophy is a condition in which one or more parts of the cornea lose their normal clarity. There are over 20 corneal dystrophies that affect all parts of the cornea. Some cause severe visual impairment while a few cause no vision problem and are discovered during a routine eye examination. Other dystrophies may cause repeated episodes of pain without leading to permanent loss of vision. Some of the most common corneal dystrophies include:

• Fuchs' dystrophy
• Lattice dystrophy
• Map-dot-fingerprint dystrophy

4. CORNEAL ECTATIC DISORDERS : These disorders are characterized by a progressive change in the shape of the cornea that results in a decrease in vision. Contact lenses are of benefit and obviate the need for surgery in most cases. However, a small portion of patients reach the point where they need a cornea transplant. Some of the common diseases include:

• Keratoconus
• Pellucid marginal degeneration
• Terriens marginal degeneration

5. CORNEAL INJURY : Corneal injuries may result from severe blunt trauma or any kind of penetrating injury. The aim is to restore and maintain the integrity of the globe, avoid further intraocular damage and prevent permanent corneal scarring and astigmatism.

Surgical facilities offered by the cornea service:

• Cornea transplantation which involves replacing a diseased or scarred cornea with a new one. In corneal transplant surgery the surgeon removes the central portion of the cloudy cornea and replaces it with a clear cornea. The chances of success of this operation have risen dramatically because of technological advances. Corneal transplantation has restored sight to many, who a generation ago would have been blinded permanently by corneal injury, infection, or inherited corneal diseases or degeneration. Recent modified forms of corneal transplant called Lamellar Keratoplasty are also performed. This involves removing only the partial thickness of the cornea that is diseased leaving the rest of the healthy cornea undisturbed. Lamellar Keratoplasty is of two types: Deep anterior lamellar Keratoplasty (DALK) and Deep lamellar endothelial keratoplasty (DLEK)

6. REFRACTIVE AND OTHER LASER PROCEDURES:

• LASIK
  LASIK, an acronym for Laser-assisted In Situ Keratomileusis, is a form of refractive laser eye surgery procedure performed by cornea specialists as an alternative for people wearing glasses and contact lenses.
• PRK
  Photo Refractive Keratectomy is an excellent alternative to LASIK in selective cases where LASIK cannot be performed due to safety considerations as corneal thickness may be inadequate.
• PTK
  Photo therapeutic Keratectomy is an excimer laser based therapeutic surgery done for numerous conditions ranging from corneal dystrophies to recurrent corneal erosions. It not only improves vision but also brings relief from recurrent episodes of painful red eye and also helps to delay the need for cornea transplantation.

Other Corneal surgical procedures:

• Amniotic Membrane Transplantation.
• Pterygium surgeries.
• Limbal Stem Cell Transplantation.
• Patch Grafts- Corneal and scleral patch grafts.
• Corneal perforation repair with anterior segment reconstruction.
• Corneal biopsy.
• Keratoprosthesis.