Today Corneal surgeries have become extremely advanced with newer techniques, equipments and research adding great value to the outcomes!Corneal transplants have now become lamellar transplants where the cornea is dissected into three parts - inner layer, outer layer and the stem cells- which can be used for three different patients. Examples being DALK, DSAEK and SLET surgeries. Also artificial corneas -keratoprosthesis- are used for patients who have very poor ocular surface with repeated transplant failures. Also corneal laser procedures for refractive errors have become advanced in the form of bladeless, flap less and touch less surgeries eg. TransPRK, Femto Lasik, Smile etc.
Advances have also been made for treating conditions like keratotoconus (conical corneas) including cross linking with UV light, thin cornea protocols, intracorneal rings and advanced contact lenses to give excellent visual acuity. The technique which a surgeon chooses depends upon the indications for the surgery as well as his clinical judgement.
Post surgery the patient needs to avoid pressure on the eyes, put his drops regularly and report immediately if there is pain, redness, watering or decreased vision. In case of emergencies like trauma the surgeries may be done in multiple sittings -first to save the globe by suturing the cornea and later to correct the opacity with a transplant or perform other procedures like cataract- glaucoma surgeries to restore vision.
Usually a patient recovers after about six weeks post surgery however treatment continues for about six months following corneal surgery. Although most cases are successful, complications can still happen including rejections, failures, cataract, glaucoma, retinal issues and infections. With due precautions, excellent techniques and equipments these can be reduced to a great extent.
Some of the interesting cases that we encountered included transplantation of corneal stem cells from a sister to her brother for treating opaque corneas following bone marrow transplant. Another case involved a chopper injury where along with the corneal transplant, cataract and retinal surgery was performed in multiple sittings and the patient got back full vision. In another case a patient was operated for inner layer transplant and blade-less laser performed for getting rid of his residual glass power. In one case of congenital cataract and glaucoma a combined cataract, glaucoma and corneal transplant were performed successfully.
Also new research is being done for lab made corneas, advanced stem cell therapy and laser based techniques. All in all it’s an exciting time for a corneal surgeon as the avenues and options available have increased dramatically and patients are being treated for many indications which were so far untouched.
Dr Harshavardhan Ghorpade
MS, DNB, FRCS, FICO, FCOS
Cornea, Ocular surface & Refractive surgeon,
DOVS Eye Institute, Fortis Hospital, Vashi, Navi Mumbai.