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Cornea & Refractive Surgery

The inability of the eye to accurately focus the rays of light coming from a distance on the retina is called refractive error. The correction of the eye to view the image correctly is refractive surgery which again depends on the condition of the eye.

Specialists:

More About the Different Available Surgeries

  • Myopia, or nearsightedness: clear vision close up but blurry in the distance.
  • Hyperopia, or farsightedness: clear vision in the distance but blurry close up.
  • Presbyopia: inability to focus close up as a result of aging.
  • Astigmatism: focus problems caused by the cornea.

More than one refractive error can occur for ex myopia and astigmatism

  • Glasses are the simplest and most popular way of correcting refractive errors.
  • Contact lens is cosmetically better though the maintenance and cleaning of the lenses may be cumbersome and have to be replaced at regular intervals.
  • Refractive surgeries are increasingly becoming popular with the advent of more predictable laser treatments.

A variety of treatments are available that correct refractive errors by changing the shape of the cornea. Through a process known as Photorefractive Keratectomy (PRK) or Laser Assisted in-Situ Keratomileusis (LASIK), mild to high amounts of nearsightedness is corrected using laser light energy produced by the excimer laser. Across the world, over 2,000,000 nearsighted people now enjoy clearer vision having undergone laser vision correction.

A new, non-laser surgical procedure to correct mild nearsightedness is now available: Corneal Ring Segments. Corneal rings are surgically placed through a tiny incision that is made on the cornea. Once in place, the two arcs flatten the cornea so that light rays can properly focus on the retina. Since the rings are inserted in the outer edge of the cornea, the center of the cornea remains untouched.

LASIK, or laser-assisted in-situ keratomileusis, combines delicate surgical procedures and laser treatment. First surgically a "flap" of corneal tissue less than a third the thickness of a human hair is created the flap to one side is lifted. Laser energy is applied to reshape the cornea according to carefully calculated measurements. When treating nearsightedness, laser is used to decrease the cornea's relative curvature. When treating farsightedness, the cornea's relative curvature is increased and then the corneal flap is repositioned. A naturally-adhering bandage, the flap helps to improve results and speed recovery. LASIK may be used for nearsightedness, nearsightedness plus astigmatism, farsightedness, and farsightedness plus astigmatism.

In PRK, or photorefractive keratectomy, the laser is applied directly to the cornea according to carefully calculated measurements, without creating a flap. For nearsightedness the relative curvature is decreased; for farsightedness the relative curvature is increased. At the conclusion of the procedure a transparent "bandage" is placed on contact lens over the cornea to promote healing. PRK is presently used to treat nearsightedness, nearsightedness plus astigmatism, farsightedness, and farsightedness plus astigmatism.

Our specialists at Prabha Eye Clinic will test your eyes completely using the best in class eye equipment and suggest a treatment that suits you the best.


CORNEA DEPARTMENT

The department caters to the efficient diagnosis and management of a wide range of diseases:

  • Refractive errors management with state of art technology.
  • Keratoconus and other corneal degenerations
  • Congential and hereditary cornea disorders
  • Corneal infections
  • Allergic eye diseases
  • Immunologic disorders of cornea

Ocular surface disorders including severe dry eye, blepharitis, chemical injuries, Stevens Johnson's syndrome,Ocular surface tumors

Surgeries

The department offers most recent advances in the field of corneal surgery which include:

Penetrating keratoplasty:

(Optical, tectonic and therapeutic) with anterior segment reconstruction, Combined with SFIOL Vitreo-retinal procedures and Paediatric PK

Lamellar corneal surgeries:

Including Deep Anterior Lamellar Keratoplasty (DALK) and Descemet's Stripping Endothelial Keratoplasty (DSEK)

Refractive corneal surgery:

Refractive surgery offers the state of art facility for various laser refractive procedures likeBladeless LASIK, LASIK,Epi-LASIK, and Wavefront guided customized ablation

Ocular surface reconstruction surgeries

Collagen Cross Linking for keratoconus using the world’s best Avedro accelerated cross linking system.

Ocular Surface Clinic:

Treats various disorders like pterygium,dry eyes , computer vision syndrome and ocular surface squamous neoplasia . Various surgical procedures like conjunctival limbal autograft, conjunctival autograft, simple limbal epithelial transplantation, amniotic membrane transplantation and mucous membrane transplantation are performed.

Specialized Contact lens fitting clinic – for irregular cornea, keratoconus and for therapeutic purposes

Recent Advances

Customized laser refractive surgery:

A strategy to correct not only the refractive error but also the other optical imperfections of the eye, known as aberrations.

Collagen cross linking for keratoconus:

A new modality for arresting progression of keratoconus by strengthening the corneal collagen fibres, involving the use of UV-Light and Riboflavin.

Facilities & Diagnostic Services

CornealTopography(PENTACAM,TMS-4)

Evaluates shape and power of corneal surface. The Pentacam, based on the Schiempflug photography is unique in that it provides invaluable information that other instruments are incapable of measuring.

Pachymetry :

Measurement of corneal thickness

Specular Microscopy

Study of the corneal endothelium (cells that maintain corneal clarity)

Anterior segment digital photography

Microbiological and histopathological evaluation of diseases of external eye diseases

Eye Bank

24 hour corneal tissue retrieval, assessment and processing under laminar flow and storage. A dedicated team that promotes awareness of eye donation. Can be contacted through dedicated telephone line 7204924365

Teaching activities

Postgraduate teaching:

Aims at providing an in-depth knowledge of various corneal disorders and diagnostic procedures to the postgraduate students.

The Cornea Fellowship training programme:

Comprehensive training programme in various aspects of medical and surgical management of corneal disorders.

This program is of one and a half year duration and starts in June of each year.

Cornea Surgery

The Cornea centre at Prabha Eye Clinic provides treatment to the diseases of cornea and epithelium such as dystrophies, infections, cornea swelling, dry eyes and injuries. A major service of this center is that of corneal transplantation including deep lamellar endokertoplasty.

ICL ie Implantable Collamer Lens

ICL is lens implant that can be used for correction of refractive errors (myopia, hyperopia, & astigmatism).

ICL is made of bio-compatible material, and it is so soft that it can be injected painlessly into the eye through a tiny opening in the cornea.

Once inside the eye it is positioned in the space between the natural lens & iris. ICL is invisible, ie it is not visible from outside. You can neither see or feel the lens once it is inside the eye.

ICL is supposed to remain permanently inside the eye. However it can be removed easily if necessary, making the procedure a reversible one.

Indications for ICL implantation

  • Mijld to High Myopia (near sightedness) and / astigmatism
  • Mild to high Hyperopia (far sightedness) and / astigmatism
  • Stable Keratoconus (post collagen crosslinking)
  • Patients not suitable for LASIK – Thin Cornea, Large pupil, Dry Eye

Preoperative assessment

Certain parameters have to be assessed to ascertain eligibility for ICL implantation. These include refraction, corneal topography, corneal thickness, corneal diameter, corneal endothelial cell count and anterior chamber depth.

Surgery

Surgery is usually performed under topical anesthesia (eyedrops). The procedure is painless and takes approximately 10 minutes to perform. A few hours later you will be able to leave the clinic and resume most of your activities. Visual improvement is noted immediately post procedure.

FREQUENTLY ASKED QUESTIONS

Am I a candidate for ICL ?

Yes if you have nearsightedness( myopia, ie minus power) or farsightedness (hyperopia, ie plus power) and/ astigmatism and no eye disease.

What are the advantages of ICL ?

The lens is very small, foldable, and injected through a tiny, pain free, self healing incision in your eye. ICL provides highly predictable outcomes, excellent quality of vision, and can be removed if necessary.

How quickly can I go back to my daily routine & activities ?

Due to the quick recovery after this treatment, you can leave the center after a couple of hours. You will be able to enjoy your new eyesight almost immediately and go back to active lifestyle . You surgeon will give you detailed advise.

What if my vision changes ?

Though unlikely if during your annual eye exam major changes in your vision are observed, ICL can be removed or replaced. With ICL you can still wear glasses or contact lenses if necessary. The lens does not treat presbyopia or eliminate the need for reading glasses due to age.

What is the long term experience with ICL ?

ICL has been available internationally for over 12 years. More than 65,000 lenses have been implanted since then.

More About the Surgery

The cornea is the transparent tissue that covers the front of the eye. The cornea is responsible to focus light onto the retina, which is at the back of the eye. Any damage to the cornea results in blurring of vision, watering and other related problems.

A major part of Corneal Surgery is corneal transplantation, including deep lamellar endokertoplasty.

A corneal transplant is performed when vision cannot be corrected satisfactorily using other procedures, or if painful swelling cannot be relieved by medications or special contact lenses. The following conditions may require corneal transplant: corneal failure after other eye surgery; keratoconus; hereditary corneal failure; corneal dystrophies; scarring after infections; rejection after the first corneal transplant; or scarring after other eye surgery

Of all the transplant surgery done today (hearts, lungs, kidneys, etc.) corneal transplants are by far the most common and successful. The latest technologies utilized at Prabha Eye Clinic offer superior corneal treatments

Preparing for the Surgery -

Surgery is usually done with local anesthesia on an outpatient basis. You may be asked to skip breakfast, depending on the time of your surgery. Once you arrive at the Prabha Eye Clinic, you will be given eye drops and sometimes medications to help you relax.

About the Surgery -

The surgery is painless. Anesthesia is either local or general, depending on the age, medical condition, and eye disease.

Post Surgery -

If you are an outpatient, you may go home after a short stay in the recovery area. You should plan to have someone else drive you home.

Follow-Up -

Following your surgery, you will need to:

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Contact Lens Fitting & Dispensing

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