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Eye Cornea Surgery: Causes, Treatments, and Risks

The cornea acts as a lens to refract, or bend light and guides most of the light entering the eye. It is a thin transparent membrane; a clear layer of tissue that smoothly covers the eyeball. Doctors generally recommend eye cornea surgery when the vision is disrupted due to damage or thinning of the cornea to retrieve and restore vision, improve its appearance, and relieve pain. Eye specialists categorize cornea difficulties as sensitivity to light, blurry vision, distressful pain, and redness. Though we somehow neglect minimalistic eye-related problems and regard them as slightly insignificant, these could lead to terrible repercussions.

Cornea transplantation: Eye cornea treatment

As intimidating as it may sound, cornea transplantation or keratoplasty is merely an intricate term simply referring to eye cornea surgery. Cornea specialists carry out this efficacious procedure with diligence and absolute care. It replaces the affected portion of the cornea with a healthy donor and eventually restores vision, enhancing the appearance and reducing discomfort. If the vision is impaired to a substantial extent, your doctor shall treat the damaged part of the cornea or its underlying cause, with the optimal manner of surgery. Several conditions can lead to such procedures:

• Keratoconus

• Vision impairment disorder: Corneal Dystrophy

• Inability to precisely focus light: Corneal Scarring

• Swelling of Cornea: Corneal Edema

• Critical injury or severe wound to the eye

Keratoconus: Cornea damage

Keratoconus is one such disease resulting in astigmatism or near-sightedness. Keratoconus alters the normal shape of the cornea and renders it protruding, like a cone. Astigmatism; gradually makes the cornea perceptively curvy, changing its form to a conical shape, differing from the normal ball-alike structure. Near-sightedness as the term indicates is the trouble of discerning things that are farther from a distance, you can only see objects or other figures which are nearer to you. A person experiencing these symptoms must consult an eye specialist immediately:

• Streaky lights

• All things appearing blurry

• Luminous lights surrounded with halos

• Double vision

• Seeing a ghost image with one eye, termed as monocular diplopia

When the damage is extensive the patient may need cornea transplantation.

Corneal Dystrophy: Painful irritation in the cornea

Affecting the front part of the eye, Corneal dystrophy is a genetic disease that usually runs in families. It may make the vision cloudy and blurry. A person diagnosed with symptoms such as painful eyes, glare, sensitivity to light, loss of corneal epithelium causing corneal abrasion or erosion may be suffering from corneal dystrophy. Watery or dry eyes, the sensation of something in the eye, or irritation and frequent feeling of eyelid sticking to the eye may also lead to corneal dystrophy. As a genetic disorder, doctors commonly suggest cornea treatment as a way to go about corneal dystrophy. If the condition is bad enough, the person might have to undergo eye cornea surgery, though the treatment depends on the type of corneal dystrophy.

Corneal Scarring: Emergence of scars in cornea

Being a resilient tissue, the cornea can typically heal from minor abrasions. Nonetheless, serious corneal damage may result in corneal scarring. Corneal scars can occur through burns, improper use of contact lenses, lacerations, or deep scratches. Symptoms may include:

• Swelling of eyelids

• Redness

• Burning sensation

• Sensitivity to light

• Scratchy sensation of something in the eye

• Pain in eyes

• Blurry vision

In case these symptoms persist, you need to consult an ophthalmologist for the desired eye cornea treatment. The doctor may ask you, initially, of the recent eye injuries and medical history other than the symptoms. Thereafter, the ophthalmologist shall conduct an eye exam in which he will look for abrasions or irritating debris. The optimal treatment will be suggested to you then. Commonly, there are three ways to medicate corneal scarring:

• Laser therapy

• Corneal transplantation

• Artificial cornea; a damaged portion is replaced with a combination of synthetic material    and the donor tissue

Corneal Edema

The swelling of the cornea due to the build-up of excess fluid is termed Corneal Edema. Speaking scientifically, the membrane called endothelium pumps out fluid from the cornea, when it becomes inactive, liquid accumulates and the cornea swells. It mostly occurs in women, as compared to men, after the age of 50. A condition called Fuch’s endothelial dystrophy causes this disorder. Things that could trigger this condition are:

• Improper use of contact lenses

• Eye surgery

• Medications

• Some medical conditions like herpes.

Eye cornea specialist will guide you to a course of eye cornea treatment if the symptoms may occur as:

• Pain in the eye when encountering discomfort due to light

• A scratchy feeling in the eye

• Ache or tenderness while touching the eyes

• Seeing halos around the lights

• In severe cases, aching blisters might emerge

The ophthalmologist will look for scars or cloudiness around your eyes or may examine the eye with an ophthalmoscope for diagnosis. Moreover, the treatment might vary on the extent to which this disorder has caused the damage.

A severe injury or wound to the eye may also lead to cornea transplantation. Though, it is more likely to be treated by the degree of damage.

Types of corneal transplantation

The advances in corneal transplantation allow surgeons to replace a part or all of the cornea, depending upon the location of the damage. Today, eye specialists consider a less invasive approach, with lower risks and quicker recovery, therefore, a partial cornea transplant can have advantages. The transplant is performed under local anaesthetic (where the area to be treated is numbed and you’re awake) or general anaesthetic (where you’re sedated and rendered unconscious). The surgery is not a prolonged one, either you may leave the eye cornea hospital the same day or stay overnight.

Largely there are four types of Transplantation:

• Penetrating keratoplasty is a procedure that involves replacing the entire cornea with a healthy donor cornea. This is the preferred technique when all layers of the cornea are opaque.

•  Endothelial keratoplasty is to replace the inner layer of the cornea with a healthy inner layer of a donor cornea. This is used to treat patients with endothelial dystrophy such as Fuch’s Dystrophy.

•  A procedure termed Keratoprosthesis involves replacing the entire cornea when a cornea is so severely damaged that it cannot be repaired with a natural donor cornea or when a previous donor cornea transplant is unsuccessful.

•  Anterior lamellar keratoplasty is a technique to replace the outer layer of the cornea with a healthy outer layer of a donor cornea. This is used mostly in patients with keratoconus and scarring of the uppermost layers of the cornea.

Risks of eye cornea surgery

As with all kinds of surgery, there are few subsequent complications of cornea transplantation. Although, most cornea surgeries are successful and hardly lead to any threats. That being said, considering the complications may be useful to the eye specialists as well to the patient:

• Cataract

•  Bleeding in the eye

• Detachment of the transplanted cornea

• Inflammation in the eye

•  Glaucoma

•  Retinal detachment

•  Incorrect vision requiring glasses or contact lenses

•  Infection inside or on the surface of the eye

Cornea transplant rejection

Another possible complication is the rejection of the donated cornea. If your immune system recognizes that the tissue is foreign and creates an immune response that rejects the new cornea then this complication can occur between several months to several years following the surgery. Cornea transplant rejection is usually reversible, and if addressed within time, may not harm the functioning of the transplanted cornea.

The overall risk for complications differs based on numerous factors that may take in your age, medical history, other eye problems, and the basic reason for your cornea transplantation. Consult your eye specialists about your risks for cornea transplantation to avoid transplant rejection.

What to expect after the eye cornea surgery?

Even though this surgery is not a drawn-out procedure, you may need to follow the post-surgery instructions as prescribed by your doctor. In the case of experiencing symptoms such as sensitivity to light, redness or pain in the eyes, and depletion in vision, you may need to consult your ophthalmologist.

The major cause for corneal transplantation: Keratoconus

Keratoconus is an eye syndrome that is progressive and can’t be reversed. When diagnosed early in the early stages, C3R therapy helps in stabilising it, and in advanced stages, corneal transplantation techniques are helpful.

The treatment options vary on the advances of this syndrome:

•  Contact lenses (RGP – Rigid Glass Permeable)

•  Corneal Collagen Crosslinking (C3R/ CXL)

•  Corneal Implants

•  Corneal Transplants

More about Corneal Collagen Crosslinking (C3R/ CXL)
This minimally invasive process enhances the corneal strength by inducing crosslinking of collagen fibres. C3R helps in stabilising keratoconus in the early stage and prevents further progression of the disease and the need for corneal transplantation. 

Corneal Transplant is a widely misunderstood procedure due to the possible risks and outcomes. Cornea specialists describe it as relatively safe and the complications are minimal and treatable.

Dr. Shilpi Gang
MBBS (Gold Medalist), MD (AIIMS, NEW DELHI), Fellow of Royal College of Physicians and Surgeons, Glasgow, U.K.
PHACO, CORNEA, FEMTO, GLAUCOMA & REFRACTIVE (Q-LASIK, ICL & BIOPTICS)

Dr. Shilpi Gang is the co-founder and CEO of ASG EYE HOSPITALS. ASG Eye Hospital has a network of 44 eye Hospitals across 33 cities of India.