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TREATMENT

When is a cornea transplant necessary?

There are many conditions that can affect the complete transparency of the cornea. For example, a trauma or injury to the cornea that can leave scars, as well as infections (especially herpes keratitis). A hereditary condition called Fuchs' dystrophy causes corneal failure. Keratoconus (see example in photo) causes the cornea to protrude forward, forming a pronounced curve. Occasionally, there may be a corneal failure after eye surgery, such as cataract surgery.

A corneal transplant is necessary if vision cannot be satisfactorily corrected with glasses or contact lenses, or if a painful swelling cannot be relieved with medication or special contact lenses.

Corneal transplant options

A cornea transplant is performed using a donor cornea. Before the cornea is removed for transplantation, tests for viruses that cause hepatitis, AIDS, and other potentially infectious diseases must be performed. The transparency of the donor's cornea is also examined.

During a traditional corneal transplant surgery (known as penetrating keratoplasty), a circular portion of the diseased cornea is removed. An equally sized circular area is cut in the center of the donor cornea, which is then placed and sutured onto the patient.

In a corneal transplant called endothelial keratoplasty, only the abnormal inner lining of the cornea is removed. A thin disc of tissue from a donor containing a healthy layer of endothelial cells is placed on the back surface of the cornea. A bubble of air is used to push the layer of endothelial cells into place until it heals in the proper position.

TREATMENT

If you have a refractive error such as myopia (nearsightedness), hyperopia (farsightedness), astigmatism, or presbyopia, refractive surgery is a method to correct or improve your vision. There are several surgical procedures to adjust the focusing ability of the eye by reshaping the cornea (the clear, round dome at the front of the eye). Other medical procedures include implanting a lens inside the eye. The most commonly performed type of refractive surgery is the LASIK procedure (Laser-Assisted in Situ Keratomileusis), which uses a laser beam to reshape the cornea.

Actually, in nearsighted people, certain refractive surgery techniques reduce the curvature of the cornea when it is too steep, so that the focusing power of the eye decreases. Images that are focused in front of the retina due to an elongated eye or steep curvature of the cornea are pushed closer or directly onto the retina after surgery.

People with hyperopia can have a refractive surgery that makes the cornea steeper to increase the focusing power of the eye. Images that focus beyond the retina due to a short eye or a flat cornea are pushed closer to or directly onto the retina after the surgery.

Astigmatism can be corrected with refractive surgery techniques that selectively reshape portions of an irregularly shaped cornea to make it smooth and symmetrical. As a result, images are focused clearly on the retina instead of being distorted by the scattering of light caused by an irregularly shaped cornea.

Refractive surgery can be a good option for you if:

You want to reduce your dependence on glasses or contact lenses.
You are free of eye diseases.
You accept the inherent risks and potential side effects of the procedure.
Understands that you may need glasses or contact lenses after the procedure to achieve better vision.
You have a suitable refractive error.
There is no universally accepted method of correcting refractive errors as the best. Your best option is to decide after a thorough examination and discussion with your ophthalmologist (Eye Doctor). If you are considering refractive surgery, provide information about your lifestyle and visual needs to your Eye Doctor to determine which procedure is most suitable for you.

TREATMENT

In the treatment of keratoconus, the course of action often depends on the severity of the symptoms. During the early stages of the disease, vision can be corrected with glasses. As the disease progresses, you may need to wear rigid contact lenses so that the light entering the eye is refracted evenly and there is no distortion in vision. It is also important to refrain from rubbing your eyes, as this can aggravate the thin corneal tissue and cause symptoms to worsen.

Keratoconus can be treated with Intacs, small devices that are implanted in the cornea and help to reshape its curve. These devices have the approval seal of the Food and Drug Administration (FDA) and can help flatten the protruding cornea typical of keratoconus.

Another treatment option for keratoconus is corneal collagen cross-linking. Approved by the FDA, corneal collagen cross-linking is a new treatment that uses a special laser and eye drops to promote cross-linking, or strengthening, of the collagen fibers that form the cornea. This treatment can flatten or stiffen the cornea, halting the development of the bulge.

When good vision is no longer possible with other treatments, a corneal transplant may be recommended. This surgery is only necessary in about 10 to 20 percent of patients with keratoconus. During a corneal transplant, the eye doctor removes the diseased cornea from the eye and replaces it with a healthy cornea from a donor.

A transplanted cornea recovers slowly. It can take up to a year or more to regain good vision after having a cornea transplant.

While a corneal transplant can relieve symptoms of keratoconus, it cannot provide perfect vision. However, among all conditions that require a corneal transplant, keratoconus has the best prognosis for clear vision.

Another type of corneal transplant that is gaining popularity for the treatment of keratoconus is deep anterior lamellar keratoplasty (DALK). During this procedure, only the front and middle layers are transplanted. Compared to a total corneal transplant, the healing period is much faster and there is a lower risk of rejection.

Treatment

The early stages of cataracts can be improved with new glasses, preferably with magnification, and proper lighting. If there is no improvement, surgery is the only effective treatment, which involves removing the cloudy lens and replacing it with an artificial lens, through an incision of 1.8mm to 2.7mm in the cornea. There are two surgical techniques for cataract surgery and the use of one or the other depends on the clinical picture that each patient presents.

Phacoemulsification surgery.

Phacoemulsification is a surgical technique widely used today for cataract surgery. Its emergence dates back to the early 1990s.

Absence of pain

The technique of phacoemulsification is not painful during or after the surgery. In fact, this surgery can be performed with topical anesthesia (eye drops) without the need for injections.

Postoperative care.

El paciente usará colirios (antibióticos y antiinflamatorios) durante 15 días aproximadamente. El mayor cuidado será no frotarse los ojos durante los primeros 20 días, luego lo podrán hacer con cuidado. Las tareas laborales “de escritorio” podrán reanudarse a la semana con un lente provisorio para la lectura. Las actividades deportivas podrán practicarse a partir de los 15 días de acuerdo a las características de las mismas.

Ventajas de esta técnica

Their benefits are:

  • Quick visual rehabilitation.
  • Quick resumption of daily activities.
  • Less ocular inflammation
  • Less postoperative astigmatism.

Risks

Facoemulsification is one of the safest and most precise surgical techniques in modern ophthalmology, but as with any surgery, there are always risks, although these are minimal. The most frequent complication is posterior capsule opacification, which is resolved by a posterior capsulotomy with a laser technique.

Use of lenses

The visual improvement without glasses is very noticeable in cataract surgery patients, and most of them can perform their normal distance vision activities without the need for glasses, but for reading they will need to use a lens and possibly a low prescription to see far details.

Integrated Medicine

When surgery for cataracts is needed in both eyes, the surgery will be performed on each eye separately, usually with four to eight weeks in between. This is one of the safest and most effective procedures, and in 90% of cases people see better after the procedure.

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