Corneal Collagen Crosslinking with Riboflavin C3-RFor keratoconus, ectasia
Keratoconus is a disease of the cornea that makes the cornea become weak and may gradually bulge outward. Most often, this bulging is in the lower half of the cornea and first presents as astigmatism, however not all astigmatism is due to keratoconus. In mild or early stages of keratoconus (forme fruste keratoconus), eyeglasses may correct the astigmatic vision.
A developing keratoconus treatment is Corneal Collagen Cross linking with Riboflavin (C3-R) that has been proven to strengthen the weak corneal structure. This method works by increasing collagen cross linking, which are the natural "anchors" within the cornea. These anchors are responsible for preventing the cornea from bulging out and becoming steep and irregular, consequence of advanced keratoconus.
During the treatment, custom-made riboflavin eye drops are applied to the cornea, which is then activated by ultraviolet light. This amazingly simple process has been shown in laboratory and clinical studies, to increase the amount of collagen cross-linking in the cornea and strengthen the cornea.
The abnormal curvature of the cornea due to keratoconus changes the cornea’s refractive error producing moderate to severe blurriness of vision. As keratoconus advances, rigid gas-permeable (RGP) contact lenses maybe the only non-surgical way to achieve clear vision. If keratoconus continues to advance, scarring of the central cornea may occur.
Approximately half of keratoconus patients have no negative lifestyle effects beyond corrective lenses. The cornea stabilizes after a few years without ever causing severe vision problems. For others, the only resolution to keratoconus has been PKP, with a long healing period and unpredictable refractive error. Even after corneal transplant PKP, keratoconus can reoccur in the new donor cornea. Fortunately, there are two new methods to treat keratoconus that are much less invasive than a corneal transplant.
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.
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.
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.
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.
Amniotic membrane transplantation has been found to :–
Facilitate epithelialization - Heal defects on the surface of eye
Maintain a normal epithelial phenotype - Stabilize cells on surface of eye
Reduce inflammation - reduces swelling
Reduce the adhesion of tissues
Amniotic membrane is used in Corneal diseases :–
Limbal stem cell deficiency
Persistent epithelial defects
Symptomatic Bullous Keratopathy Conjunctival diseases -
Conjunctival surface reconstruction
Trabeculectomy Bleb Leakage or Revision
PTERYGIUMA pterygium is a growth of scar tissue and blood vessels on the sun-exposed surface of the eye in response to ultraviolet damage from the environment. A pterygium often grows in a wing shape, which extends across the cornea towards the pupil. Pterygium most often occurs on the inner side of the pupil. The best treatment for pterygium is prevention. Wearing wrap around sunglasses when exposed to sun and wind will prevent a pterygium. Decongestants simply disguise the redness while the pterygium grows Conjunctival Autograft with Stitches
Most cornea specialists today perform pterygium surgery with a conjunctival autograft because of a reduced risk of recurrence. In this technique, the pterygium is removed, and the cornea regains clarity. However, the gap in the mucous membrane (conjunctiva) tissue, where the pterygium was removed, is filled with a transplant of tissue that has been painlessly removed from underneath the upper eyelid. Although the procedure requires more surgical skill than traditional surgery, this "auto-graft" (self-transplant) helps prevent re-growth of the pterygium by filling the space where abnormal tissue would have re-grown.
The autograft is held in place with tiny stitches that may dissolve after a few weeks or can be removed in the surgeon's office. Stitches on the eye frequently cause discomfort, however, after pterygium/autograft surgery. The desire for a quicker, more painless recovery has led to the development of no-stitch pterygium/autograft surgery.
No-stitch Pterygium/Autograft Surgery*
No-stitch pterygium/autograft surgery allows most patients to return to work within one or two days of
No-stitch surgery is made possible by the use of modern tissue adhesive. Composed of clotting proteins normally found in human blood, tissue adhesive allows the surgeon to secure a conjunctival autograft in seconds rather than minutes. After about one week the tissue adhesive dissolves with no residue, leaving the eye to heal comfortably.