Cornea specialist in Mumbai
What Is Cornea?
The corneal is the most vital part of the eye as it performs the two primary functions:
- It covers and protects the pupil, the iris, the anterior chamber and other interior parts of the eye
- It refracts and focuses most of the light that enters the eye onto the retina, contributing to two-thrid of the refractive power of the eye.
It is a transparent avascular tissue layer, i.e. it doesn’t contain any blood vessels for nutrition. It receives all its nutrients from the tears, external air and the aqueous humour within the eye. Hence, it regenerates quickly from small abrasions as compared to other parts.
Cornea, along with the tear layer and sclera, forms the outer coating of the eye. This coat prevents the internal parts from being exposed and be affected by surrounding elements while forming an anterior refractive surface.
Cornea comprises of five distinct layers i.e., corneal epithelium, Bowman’s layer, corneal stroma, Descemet’s membrane and corneal endothelium which individually perform their unique functions to keep the cornea intact and refract maximum amount of light falling on the eye.
What Are The Most Common Corneal Disorders?
The corneal surface is vulnerable to a range of infections, diseases and disorders. Following are some of the commonly occurring conditions that damage the corneal surface:
When the corneal surface gets scared or degraded, its damaged surface fails to refract the incident light accurately onto the retina. This condition turns the otherwise clear cornea appear white and make your vision cloudy.
Corneal opacity is usually caused due to one or a combination of the following factors:
- Vitamin A deficiency
- Wearing contact lenses for an extended period
- Injuries or contact with foreign bodies
- Corneal scars caused by infectious agents such as bacteria or herpes simplex virus
- Keratoconus, Stevens-Johnson syndrome, conjunctivitis, and other eye conditions
- Congenital corneal abnormalities
If your eye starts clouding, it is a clear symptom of opacity. However, before the appearance of visible clouding, you may also experience other signs such as:
- Loss or blurriness in the vision
- Pain, irritation or itching sensation in the eye
- Eye redness or excessive tearing,
- High sensitivity towards sunlight
- Areas with milky patches in the eye
Corneal opacity is initially treated with eye drops and medications. In critical cases, Phototherapeutic keratectomy (PTK) laser surgery can prove more effective. Advanced cases can be helped by cornea transplantation
Keratoconus (KEHR-a-toh-kohn-nus) is a non-inflammatory eye condition in which the usually round, dome-shaped cornea thins and protrudes in a cone-like bulge, resulting in significant visual distortion. As the cornea is responsible for refracting most of the light coming into the eye, such abnormalities adversely affect the simple tasks, like driving, watching TV or reading a book.
The symptoms usually first appear in the late teens and early twenties. Keratoconus may progress for 10-20 years and then slow in its progression. As keratoconus progresses, the cornea bulges and thins, becoming more and more irregular, blurry and sensitive to light.
Research suggests that an imbalance of enzymes within the corneal tissue causes it to weaken and lead to thinning & bulging of the cornea. Some commonly observed causes of keratoconus development include:
- Genetic predisposition, causing oxidative damage
- Overexposure to ultraviolet rays
- Excessive eye rubbing
- Chronic eye irritation
- Wearing poorly fitting contact lenses
Along with the blurred vision, keratoconus can also show signs such as:
- Progressive nearsightedness and irregular astigmatism
- Glare and light sensitivity
- Frequent fluctuation in eyeglass and lens prescription
Keratoconus can be managed with a combination of cornea collagen crosslinking (CXL), contact lenses and eyeglasses. The need for cornea transplants is uncommon with modern management techniques. As it develops unpredictably, the lenses are customized based on the patients existing eye condition. The practitioner carefully evaluates the needs of the individual situation to find a lens that would offer the best combination of visual acuity, comfort and corneal health. You can learn more about contact lenses for keratoconus here…
The endothelium layer of the cornea is responsible for pumping back any fluid that flows through the eye. As these endothelial cells cannot regenerate, when they get damaged, fluids start to accumulate near the cornea causing it to swell. This swelling and clouding state of the cornea is known as Corneal Edema.
It is most commonly associated with other eye disorders such as Fuchs’ endothelial dystrophy, Endotheliitis, Glaucoma, Posterior polymorphous corneal dystrophy, and in rare cases, with Chandler’s syndrome.
Cataract surgery has also been found to damage the endothelial cells leading to corneal oedema.
Use of certain drugs such as chlorhexidine, amantadine and the ones that contain benzalkonium chloride can also increase the risk of developing corneal oedema.
People who develop this condition often show symptoms such as eye pain, seeing halos and glares around lights and feeling like something’s stuck in the eye.
What are the Treatments For Corneal Problems?
Keratoplasty or cornea transplant surgery is warranted when the cornea becomes dangerously thin or when one can no longer use contact lenses due to the steepness of the cornea.
If the rest of the eye (including the retina and optic nerve) is healthy, the cornea is replaceable through transplant surgeries. Corneal transplantation is one of the most successful organ transplant surgeries. The success of the procedure depends on the amount and type of damage the eye has sustained from disease or injury.
Cornea Transplant Procedure: Layered cornea transplantation: with new techniques separate layers of the cornea can be transplanted as needed e.g. epithelium, stroma or inner cell lining (endothelium).
- In most cases, this cornea replacement surgery is done on an outpatient/daycare basis, and local anaesthesia is used during the procedure.
- Your eyelids are carefully washed and covered with a sterile plastic drape.
- The entire procedure is performed under a microscope. A circular cookie cutter-like instrument, called a ‘trephine’, is used to remove the centre of the diseased cornea.
- A button-shaped tissue layer of similar size is removed from the donor cornea.
- This donor tissue is then sewn in place of the patient’s cornea with extremely fine nylon sutures.
- A patch and shield are applied to protect the eye from foreign contact.
Corneal transplant for keratoconus can be performed in two ways: Penetrating keratoplasty (full-thickness corneal transplant) and Deep anterior lamellar keratoplasty (DALK) surgery.
In Penetrating keratoplasty surgery, the entire central disc of the cornea is replaced with a similarly sized disc of a donor cornea. In DALK surgery, the healthy endothelial layer of the patient’s cornea is retained will the frontal two to three damaged layers are removed. The endothelial layer is the most vital layer of the cornea responsible for maintaining corneal clarity.
The other advantage of lamellar keratoplasty is that as the inner layer is retained, the immune cells of the body do not recognize the outer donor tissue as being foreign. Hence there is no risk of endothelial rejection with lamellar keratoplasty.
You can find more in-depth information about keratoplasty on this page.
DSAEK is a new technique of cornea transplant with a shorter recovery time and better vision after surgery.
In this procedure, the surgeon removes the endothelium, the innermost layer of the cornea, along with Descemet’s membrane and replaces it with a delicate, healthy layer of cornea tissue from the donor.
The surgery is done with specialised tools, and the new corneal tissue is delicately positioned into the cornea and left for healing without sutures.
Who needs DSAEK?
People need DSAEK cornea transplants to treat:
- Fuchs’ dystrophy, a traumatic injury to the eye area
- Endothelium affected by previous eye surgery or particular eye disease
- A disease or injury which is slowly destroying endothelium and leads to blindness.
The DSAEK cornea transplant can effectively help restore vision.
Before your surgery, your surgeon will ask for the EKG, chest x-rays, and blood sample tests and check your prescription medications.
The surgery will be done under local anaesthesia, given to numb your eye and prevent eye movement. Your surgeon will make a small incision on the cornea to access its inner layers. Your cornea will be incised and replaced by a healthy corneal layer.
The entire procedure takes about one hour. The donor cornea will adjust in position soon, and the front cornea will not require any sutures or incisions. Hence you can expect a quicker recovery time.
After Procedure: What to expect
You will have to stay in the center for at least one hour after surgery for monitoring. Your eyes will be dressed. You will have to put antibiotics or steroid drops in your eyes to prevent infection.
A patient who had a DSAEK procedure can regain good vision within two to eight weeks.
Corneal transplantation can help an eye with a damaged cornea regain functional vision when necessary. However, the procedure’s risks, like all procedures, must be weighed against the degree of hardship the patient is dealing with due to their corneal disease.
Deep anterior lamellar keratoplasty, or DALK, is a partial thickness graft that keeps the endothelium and Descemet’s membrane, the two innermost layers of the cornea, intact. Retaining the host’s endothelium layer is the aim of the procedure. This layer keeps the cornea clear by drawing fluid away from the most cornea.
The risk of possibly blinding graft rejection that might happen with penetrating keratoplasty is avoided by keeping this layer. If the endothelium layer is healthy, it should be protected.
Fewer postoperative problems, a lower likelihood of rejection, and a shorter duration of topical steroid therapy are some potential advantages of DALK.
Graft rejection is a frequent risk factor for corneal transplant failure. About 10% of conventional Penetrating Keratoplasty (PK) cases experience rejection. Most frequently, the donor endothelium is the source of rejection. The likelihood of rejection from the other layers of a transplanted cornea is substantially lower. The endothelium is preserved in DALK, which reduces the likelihood of rejection.
The procedure includes cutting the cornea close to its 95% thickness and eliminating the top layer, which requires technical competence. Next, Descemet’s membrane and donor endothelium are removed to prepare a donor corneal button. The host is then sewn to the donor graft. Although it takes a bit longer to clear the cornea, the visual outcomes can be comparable to those of a penetrating keratoplasty.
Even years after the initial transplant, corneal transplants are susceptible to significant injury that could cause the eye to rupture since the transplant never recovers as strongly as a natural cornea. Because of this, extra care and some limits are needed for life after receiving a corneal transplant, which must be considered before surgery. After a full-thickness transplant, the visual recovery period usually lasts one year. Patients are attentively watched throughout this recovery time to ensure normal wound healing and to change sutures as necessary to improve the appearance. Suppose a patient has had a corneal transplant. In that case, it is advised that they call immediately if they experience any pain, blurred vision, light sensitivity, or redness, as these symptoms could indicate a broken suture, an infection, or graft rejection that must be treated.
Frequently Asked Questions:
Although some corneal conditions are congenital, it is also common in people who have jobs and hobbies that involve:
- Sports that use a ball or puck, like baseball or hockey
- Lawn Mowing or using a weedwhacker
- Painting, welding and hammering
- Machines like sanders or drills
- Chemicals such as bleach or pesticides
Corneal conditions can be diagnosed in their early stages with periodic eye exams. The dilated eye exam is a painless and straightforward process used for such diagnosis.
Eye drops of fluorescein dye are used to check for corneal abrasions. These drops make small abrasions noticeable, helping the cornea specialist in Mumbai during early-stage diagnosis.
Like any surgery, corneal transplant surgery has some risks. A major risk is if your body sees the new cornea as a foreign object, it tries to get rid of it. Other risks include infections, bleeding, retinal detachment or formation of Glaucoma.
Corneal transplant is performed as an outpatient surgery. Depending on the type of transplant, it can take up to a year to fully recover. It is recommended that you make a follow-up appointment the day after surgery to check how your eye is healing and talk with your doctor about when you can get back to your normal activities.
Today, it is relatively easy to get a cornea eye surgery and specialist surgeons are also widely available. However, before you start looking for cornea specialist doctors in Santacruz, Mumbai, you must know that cornea treatments require highly skilled doctors and advanced devices to minimize the risks and side-effects. Hence, look for an eye clinic which utilizes the latest technology and has experienced ophthalmologist to guide you.
The cornea is the outermost protective layer, and its functions can be specified as follows;
- It acts as a shield for the rest of the eyes and protects them from germs, dust, and other harmful matter.
- It shares a protective task with other eye parts such as eyelid, eye socket, and the sclera.
- The cornea acts like a window that controls and focuses light into the eye.
- Without cornea, lens and retina would be highly susceptible to ultraviolet rays.
Since the cornea is the outermost layer, it has a higher risk of being affected and infected. The cornea can be affected by:
- Abrasion– When the surface of the cornea scratches or is scrapped, it is called abrasion to the cornea.
- Chemical injuries – When our eyes are exposed to chemicals, they turn red because of damage to the cornea.
- Contact lens misadjustment– Adjustment of contact lenses abrades cornea, and its regular usage and adjustment erode and harms it.
- Foreign particle entry– Foreign particles include gritty substance like sand and dust particles that erodes the sheath causing harm to the cornea.
- UV injury– Prolonged exposure to the sun’s ultraviolet rays is known to damage the corneal layer.
An open sore or erosion in the cornea’s surface is called a corneal ulcer. Typically, infection, physical or chemical injury causes exposure or dryness to the cornea that further causes corneal ulcers. If you face corneal problems, it is better to consult a cornea specialist in Mumbai than to delay, which will aggravate the situation.
At Clear Vision, we ensure that every patient receives the best treatment from our side because we understand the importance of vision for you. You can be sure to receive the best cornea treatment in Mumbai with us. To answer why you choose us, take a glimpse below.
- We are well equipt with the latest technology to cater to the needs of your eyes.
- Our team works in synchronisation following a result-oriented approach.
- If you plan to donate your eyes, you can trust us to provide vision to the needy using your cornea.
- We have a team of well-qualified doctors who attend to patients in a very professional yet personalised way.