Corneal Collagen Crosslinking with Riboflavin C3-R
	Cornea transplant (Penetrating keratoplasty)
	Infectious Keratitis
	PTERYGIUM
	AMNIOTIC MEMBRANE GRAFT

Corneal Collagen Crosslinking with Riboflavin C3-R

Cornea transplant (Penetrating keratoplasty)

Corneal transplant procedures may restore vision to otherwise blind eyes in some cases. There are many conditions in which corneal transplantation may be considered. The most frequent indication is pseudophakic bullous keratopathy, which is a corneal decompensation that occasionally follows cataract surgery. Pseudophakic bullous keratopathy may account for about 17% of all corneal transplant procedures. Less frequent indications include corneal ulceration, corneal scars, keratoconus, herpes simplex and Varicella zoster viral infections leading to scarring, Fuch’s endothelial dystrophy, congenital opacities of the cornea, and chemical burns of the eye.


The donor cornea is prepared using a punch or corneal trephine to create the corneal “button.” The corneal button will become the transplanted cornea. The diseased, or scarred cornea is then removed using a corneal trephine, creating a “bed” for the transplant cornea. Finally, the donor cornea is gently sewn into place with ultra-fine sutures (approx. one-third the thickness of human hair, or less). 

Corneal transplantation may be combined with other procedures, particularly cataract extraction with intraocular lens implantation.

Postoperatively, patients should expect very gradual recovery of vision. In fact, the best vision may not be obtained for six to 12 months or more following surgery, even though vision may be improved from the first day after surgery in some cases. The surgeon will likely begin to remove some sutures from the cornea within a few weeks to a few months after surgery. However, all of the sutures need not be removed. In general, sutures are removed to help alleviate astigmatism once the cornea begins to show signs of being glasses or contact lenses for visual correction.

Advantages    : Good optical clarity
Disadvantages: Risk of open eye surgery (haemorrhage, infection)
                           Risk of graft rejection
                           Astigmatism
                           Stitch related problems

Infectious Keratitis

Infectious keratitis refers to a family of conditions associated with microbial invasion of the corneal epithelium and stroma. The organisms can be bacteria, fungi and viruses. The appearance can vary widely depending on the infecting organism and the stage of the disease at the time of presentation. Typically there is significant necrosis of tissue and associated inflammation. Corneal ulceration, loss of epithelium with underlying stromal infiltrate, characterizes the classic presentation. Associated anterior chamber inflammation is common. The possibility of permanent visual loss from corneal scarring or perforation makes microbial keratitis a dreaded condition.
Dry Eye Syndrome

Dry eye syndrome is one of the most common problems treated by eye physicians. It is usually caused by a problem with the quality of the tear film that lubricates the eyes. 
Tears are comprised of three layers.  The mucus layer coats the cornea, the eye’s clear outer window, forming a foundation so the tear film can adhere to the eye.  The middle aqueous layer provides moisture and supplies oxygen and other important nutrients to the cornea.  This layer is made of 98 percent water along with small amounts of salt, proteins and other compounds.  The outer lipid layer is an oily film that seals the tear film on the eye and helps to prevent evaporation.  
Tears are formed in several glands around the eye.  The water layer is produced in the lacrimal gland, located under the upper eyelid.  Several smaller glands in the lids make the oil and mucus layers.  With each blink, the eyelids spread the tears over the eye.  Excess tears flow into two tiny drainage ducts in the corner of the eye by the nose.  These ducts lead to tiny canals that connect to the nasal passage.  The connection between the tear ducts and the nasal passage is the reason that crying causes a runny nose. 
In addition to lubricating the eye, tears are also produced as a reflex response to outside stimulus such as an injury or emotion.  However, reflex tears do little to soothe a dry eye, which is why someone with watery eyes may still complain of irritation. 
Dry eye syndrome has many causes.  One of the most common reasons for dryness is simply the normal aging process.  As we grow older, our bodies produce less oil – 60% less at age 65 then at age 18.  This is more pronounced in women, who tend to have drier skin then men.  The oil deficiency also affects the tear film.  Without as much oil to seal the watery layer, the tear film evaporates much faster, leaving dry areas on the cornea.
Many other factors, such as hot, dry or windy climates, high altitudes, air-conditioning and cigarette smoke also cause dry eyes.  Many people also find their eyes become irritated when reading or working on a computer.  Stopping periodically to rest and blink keeps the eyes more comfortable. 
 
Contact lens wearers may also suffer from dryness because the contacts absorb the tear film, causing proteins to form on the surface of the lens.  Certain medications, thyroid conditions, vitamin A deficiency, and diseases such as Parkinson’s and Sjogren’s can also cause dryness.  Women frequently experience problems with dry eyes as they enter menopause because of hormonal changes.  

When it comes to treating dry eyes, everyone’s needs are a little different.  Many find relief simply from using artificial tears on a regular basis.  Some of these products are watery and alleviate the symptoms temporarily; others are thicker and adhere to the eye longer.  Preservative-free tears are recommended because they are the most soothing and have fewer additives that could potentially irritate.  Avoid products that whiten the eyes – they don’t have adequate lubricating qualities and often make the problem worse. Some of the newer medications may have to be used on a long term basis and maybe expensive.
Closing the opening of the tear drain in the eyelid with special inserts called punctal plugs is another option.  This works like closing a sink drain with a stopper.  These special plugs trap the tears on the eye, keeping it moist.  This may be done on a temporary basis with a dissolvable collagen plug, or permanently with a silicone plug. 
There are also simple lifestyle changes that can significantly improve irritation from dry eyes. Make a conscious effort to blink frequently – especially when reading or watching television.  Avoid rubbing the eyes.  This only worsens the irritation. 

AMNIOTIC MEMBRANE GRAFT

The amniotic membrane, or amnion, comprises the innermost layer of the placenta. Amniotic membrane transplantation (AMT) has been used in many different types of reconstructive surgery. The ophthalmic uses of human amniotic membrane for transplantation are many and its discovery has greatly improved our ability to treat debilitating ocular surface disease. Amniotic membrane has found its use in diverse eye diseases. AMT became important because of its ability to diminish the occurrence of adhesions and scarring, its ability to enhance wound healing. In particular, the amniotic membrane expresses incomplete HLA-A, B, C, and DR antigens, which may account for the fact that immunological rejection after transplantation has not been observed.

PTERYGIUM