Cornea

Karthik Netralaya offers comprehensive corneal services by a team of dedicated consultants. The cornea is the outermost part of eye. This clear, transparent membrane covers other eye anatomy including the iris and pupil. The cornea functions as a protector for other eye components and also provides the eye most of its optical power.

Cornea Grafting

Corneal grating or also known as cornea transplant is a surgical procedure wherein the damaged tissues on the eye’s clear surface are replaced with graft. If the graft is partial it’s called as lamellar keratoplasty, if the corneal tissue replaces the damage tissue entirely it’s called penetrating keratoplasty.

C3-R (Corneal Collagen Cross-linking with Riboflavin)

Corneal collagen cross linking with riboflavin (C3-R) is the only non-surgical treatment that is proven to prevent the progression of keratoconus, and it may even be able to reverse the condition to some extent.

What is keratoconus?

Keratoconus is a progressive condition affecting the cornea of the eye. The cornea is the clear window at the front of the eye. It is a curved structure. The precise shape of the curve allows it to act as a lens, projecting an image into the eye. The cornea is made up of bundles of protein called ‘collagen’. These bundles are normally held tightly together by chemical links between the collagen strands. This ensures that the shape of the cornea is constant. The problem with the keratoconic cornea is that the normal chemical links between collagen strands are deficient, causing the cornea to be unusually elastic. The pressure inside the eye then pushes the cornea into a distorted, conical shape. This spoils the quality of the image projected into the eye, and the vision becomes progressively blurred.
 

                                               Normal        Vision with Keratoconus

Keratoconus

What are the symptoms?

At early stages, the person feels the need for frequent change of spectacle correction. As the disease progresses, the vision deteriorates. Visual acuity becomes impaired at all distances, and night vision is sometimes quite poor. Keratoconus can cause substantial distortion of vision, with multiple images, streaking, sensitivity to light, eyestrain from  squinting  in order to read, & itching in the eye.

How it is diagnosed?

This is usually done by an Ophthalmologist with a detailed eye examination including retinoscopy, keratometry, slit-lamp examination etc. Diagnosing early keratoconus can be tricky, since mild disease often does not show any signs on slit-lamp examination. Streak retinospcopy can pick up early Keratoconus. At Karthik Netralaya  a very sensitive instrument called the ‘Pentacam HR’  is used for early diagnosis.  This is an automated instrument working on Shiemflug principal, and can pick up extremely early Keratocouns, that often starts in the back of the cornea.   The various parameters of the degree and extent of the deformation is are used for assessing progression.

How Keratoconus is treated?

Treatment of mild to moderate keratoconus is done temporarily by Contact lenses, which can be the regular RGP or specific and specialised, like Rose K lenses and mini scleral  contact lenses depending upon the severity of the illness. The new modality of treatment is Corneal Collagen Crosslinking with Riboflavin (C3-R) stablises the cornea from further deteriorating. In severe stages the person has to undergo corneal grafting surgery.

What is collagen cross-linking?

A new modality of treatment for mild to moderate keratoconus in which riboflavin eye drops are applied to the eye. The Riboflavin, when activated for approximately 15-30 minutes with UV-A light, strengthens the collagen cross-links within the stroma and so recovers some of the cornea's mechanical strength.  CSL or C3R has been shown to slow or arrest the progression of keratoconus, and in some cases even reverse it to an extent.                                                                          



 

 

 

 

How does Cross Linking arrest Keratoconus?

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,  which is the cause for keratoconus.                                                                                                        

Corneal collagen cross-linking (CXL) is established as an effective surgical treatment to increase the biomechanical stability of the cornea. We use CXL to treat idiopathic Keratoectasia such as keratoconus and pellucid marginal degeneration and post-LASIK ectasia etc.

The introduction of collagen cross linking (C3R, CXL, CCR, CCL and KXL) therapy promises to arrest the progression of conreal illensses. . The indications for CXL seem to be expanding dramatically, beyond conventionals.  CXL is now being used preventively along with LASIK (called LASIK plus) and ASA (advanced surface ablations) in those who have risks of developing keratectasia as shown on Pentacam HR analysis. Conventional CXL machines cannot be used for these advanced treatments, and our new INTACS XL will be of enormous use in these special indications.

INTACS XL is a UVA collagen cross linking instrument designed with special focus on usage, effective performance and safety.  It is a versatile UV irradiating device for performing a corneal cross-linking procedure at a wavelength at 365mn, designed with illumination intensity in the range of 3.0Mw/Cm to 30.Mw/Cm at a working distance of 50mm. While conventional machines take 30 minutes to deliver the UV dosage, this new machine delivers it in 3 minutes. This means quicker treatment, and better cooperation by the patient during the treatment.

Corneal Collagen Cross-linking Equipment

 

 

 

 

 

 

 

                                                              

Intacs XL  a Safe and effective CSL method to arrest progression of Keratoconus

Facilities: Cornea Grafting at Karthik Netralaya

  • Advanced Intacs XL Corneal cross linking equipment
  • Corneal topography Tomey IV Topographer
  • Spectral domain Corneal OCT
  • Computerized Contact Lens module for Keratoconus contact lens fitting Low visual aids to enhance vision in those with uncorrectable vision
  • Deep lamellar & endothelial (DALK & DSAEK) cornea penetrating keratoplasty
  • ‘Automated Corneal Shaper’ (ACS) for lamellar corneal grafting surgeries