Corneal disease surgery


A cataract is a clouding of the normally clear lens of your eye. For people who have cataracts, seeing through cloudy lenses is a bit like looking through a frosty or fogged-up window. Clouded vision caused by cataracts can make it more difficult to read, drive a car (especially at night) or see the expression on a friend's face.
Most cataracts develop slowly and don't disturb your eyesight early on. But with time, cataracts will eventually interfere with your vision.
At first, stronger lighting and eyeglasses can help you deal with cataracts. But if impaired vision interferes with your usual activities, you might need cataract surgery. Fortunately, cataract surgery is generally a safe, effective procedure.

In most patients with keratoconus, contact lenses can be fitted and their vision improved. However, surgery is the next option when the disease becomes intolerable and patients no longer wear contact lenses. Surgical options include intracranial corneal ring sections (ICRS), deep anterior layer layered keratoplasty (DALK), and penetrating keratoplasty (PK).
Non-FDA treatments, which usually have less evidence-based information about safety and efficacy, include the use of corneal cross-linking that has been experimentally combined with excimer laser treatment, conductive keratoplasty, and / or ICRS. Some surgeons use phakic IOLs to correct myopia or some astigmatism. ICRS is also approved for the treatment of mild to moderate keratoconus in patients with lens intolerance. In these cases, patients should have a clear central cornea with a corneal thickness> 450 microns in those areas, approximately in the 7 mm light region.
The advantage of ICRS is that they do not require corneal tissue removal, they do not have an intramuscular incision, and they leave the central cornea intact. For the best patients, for the best vision, there is a need for glasses and / or contact lenses after the operation, but it will have flatter corneas and the lenses will be easier to use.
If a patient does not get the expected results, the ICRS can be removed and then other options for surgery are considered. DALK involves the replacement of the central anterior cornea and the patient's endothelium does not remain intact. The advantage of this is that the risk of rejection of the endothelial graft is eliminated, and there is less risk of damaged rupture of the earth in the incision, because the endothelium and Descemet and some stroma remain intact and regain vision faster.
There are a variety of techniques, including manual analysis and the large bubble technique to remove the anterior stroma when releasing the Descemet layer and endothelium. However, these procedures can be technically challenging, requiring penetrating keratoplasty, and postoperatively there is a possibility of medial fusion leading to a reduction in BCVA. It is not known whether astigmatism is better treated with DALK vs PK.
PK is highly successful and is a standard surgical procedure with a long history of safety and efficacy. Risks of this procedure include infection and corneal rejection and the risk of rupture of the injury at the margin of the wound. Many patients after PK may still need hard or permeable contact lenses due to irregular astigmatism.
Any type of refraction method due to the unpredictability of the outcome and the risk of occurrence leads to an increase and unstable irregular astigmatism in keratoxionic patients. Follow-up surgery Following any corneal surgery, patients should be followed for complete visual rehabilitation.
Most patients still need vision correction with glasses or contact lenses, and often require hard or permeable gas if there is a high level of astigmatism. All surgical patients should be considered to ensure wound healing, infection assessment, suture removal, and other routine eye care such as glaucoma, cataract, and retinal examinations.
Transplant rejection can occur after penetration into the keratoplasty and requires prompt diagnosis and treatment to ensure the transplant survives. Complications of infection, poor wound healing, corneal transplant rejection, corneal resection, thinning of the host graft junction, glare, irregular astigmatism, and high refractive error.
The prognosis for penetrating keratoplasty in a patient with keratocytosis is excellent, so that most patients are able to return to an active lifestyle and achieve personal goals. ICRS can provide long-term success for patients with keratoconus, but this is commonly associated with the use of contact lenses, and some of them may eventually undergo corneal transplantation to achieve their vision rehabilitation goals.
"Progression" of keratoconus has been reported, even after corneal surgery, but it is unclear how common or to what extent this may occur.
Full-thickness corneal transplantation may require your entire cornea if both the inner and inner layers of the cornea are damaged. This is called penetrating keratoplasty (PK) or full-thickness corneal transplantation.
Your diseased or damaged cornea will be removed. The clear donor cornea is then sutured in place. PK has a longer recovery period than other types of corneal transplants. Complete vision retrieval after PK may take a year or more. With PK, there is a slightly higher risk than other types of corneal transplants that the cornea will be rejected.
This is when the immune system attacks new corneal tissue. Corneal grafts with partial thickness Sometimes the front and middle layers of the cornea are damaged. In this case, only those layers are removed.
The endothelial layer or thin dorsal layer is held in place. This is called a deep anterior lamellar keratoplasty (DALK) or a partial corneal transplant. DALK is commonly used to treat keratoconus or corneal bloating. Recovery time after DALK is shorter than after complete corneal transplantation. There is also a lower risk of corneal rejection.
Endothelial keratoplasty In some conditions of the eye, the inner layer of the cornea called the "endothelium" is damaged. This causes the cornea to swell and affects your vision. Endothelial keratoplasty is a surgery to replace this layer of cornea with healthy donor tissue. This is known as a minor graft because only this inner layer of tissue is replaced.
There are several types of endothelial keratoplasty. They are called: DSEK (or DSAEK) - Stripping Endothelial Keratoplasty (Auto) DMEK - Descemet Membrane Endothelial Keratoplasty removes any damaged cells from the inner layer of the cornea called the Descemet Membrane. The damaged layer of the cornea is removed through a small incision.
The new tissue is then placed in place. Only a few stitches are needed to close the incision (if any). Most of the cornea remains intact. This reduces the risk of rejection of new corneal cells after surgery. Some things to know: With DSEK / DSAEK surgery, the donor tissue may be transplanted and positioned easier because DMEK surgery is thicker than the donor tissue.
In DMEK surgery, the donor tissue is thin and more difficult to transplant. But recovery is faster because the connective tissue is thinner. Your eye surgeon selects the type of operation based on the condition of your cornea.
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