Download MBBS Ophthalmology PPT 30 Diseases Of The Cornea 4 Lecture Notes

DISEASES OF THE CORNEA

Department of Ophthalmology

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Xerophthalmia

n Deficiency of vitamin A(dietary def. or

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defective absorption)

n Young malnourished children often in the

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1st year of life

n Usually bilateral

n Absence of inflammation

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n Precipitated by acute systemic illness


Xerophthalmia

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n XN night blindness

n X1A conj. Xerosis

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n X1B Bitots spots

n X2 Corneal xerosis

n X3A Keratomalacia<1/3

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n X3B Keratomalacia>1/3

n XS Corneal scarring

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n XF Xerophthalmia fundus

Bitot's spots (X 1B)

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Corneal xerosis(X2)

Keratomalacia (X3B)
Treatment of xerophthalmia/ keratomalacia

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n Local ocular therapy

n Vitamin A therapy - XN X3B
> 1 year 200,000 IU orally/100,000 IM
on day 0, 1, 2 weeks later

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6-12 months or < 8kg half the dose
<6 mths 50,000 IU
Treatment of underlying condition

Prophylaxis against xerophthalmia

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WHO recommendations

6-12 mths/ < 8kg 100,000 IU orally 3-6

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monthly

>1yr <6yrs 200,000 IU orally 6

monthly

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Lactating mothers 20,000 IU orally at

delivery

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WHAT IS AN EYE DONATION

n It is donation of transparent

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glass (Cornea) from donor to

recipient having Corneal opacity

with normal posterior segment

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Magnitude Of The Problem in India

n 20% of blind population of the world

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n 15 million total blind in India

n 6-7 million are corneal blind

n 1 million bilateral blind

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(90% below age 45 yrs including 60% children

below 12 yrs)
Magnitude of The Problem

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n Required collection ? 2,00,000( 50% utilization)

n Current Collection 2017? 52960

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EBAI- 2017 Stats for INDIA(Unpublished data)

Magnitude of the Problem in India

nRequired transplant ? 1,00,000 cornea

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n Current transplants (2017) ? 25153

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EBAI- 2017 Stats for INDIA(Unpublished data)
n We have achieved 0.25% of all deaths
- 25 donation / 10,000 deaths

n Target is 1% of total deaths

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- 100 donation /10,000 deaths

With a goal of 100,000 transplants and utilization

of 50%

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Causes of Corneal

Blindness

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Corneal Infections

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Vasculrized Corneas with

thinning

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Sloughing Cornea with

Perforation

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Vitamin A Deficiency


Traumatic Corneal Opacities

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Chemical Burns


Corneal Dystrophies &

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Degenerations

Congenital Corneal

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Opacities

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Surgical Trauma

Demand Vs supply of cornea

n 1 lakh Cornea needed per year

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n 30-40,000 new Corneal blind are

added every year

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n 50,000 eyes collected in India every

year

n 8-9 million death occur every year in

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India

n To clear the backlog we need at

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least 277,000 corneas
Eye Bank

n Is an organization which deals with

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- Collection

- Storage

- Distribution

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For the purpose of corneal grafting and

research

Functions of Eye Bank

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n To promote eye donation

n Registration of pledger for eye

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donation

n Collection and processing of eyes as

per Eye Bank standards

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n To evaluate the quality of tissue

before use

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n Preservation of Tissue

n Distribution of tissue

n Research activities

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Assessment of Donor Cornea

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Preparing a Corneo-Scleral

Button

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Placing Donor Cornea in

MK Medium for Preservation

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Keratoplasty

Types of keratoplasty

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n Lamellar SALK
DALK
DSEK
DMEK

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n Penetrating
optical
therapeutic
tectonic
n Rotational autografts

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Removing diseased host corneal button

Donor corneal button

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Placement of graft over the recepient eyeball

Corneal Graft in place

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Refractive corneal surgeries

n Substraction procedures
- Photorefractive keratectomy (PRK):

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eximer laser is used in the center optical

zone.

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n Laser assisted in situ keratomileusis

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(LASIK):

- 130-160micron flap is raised

- mid stromal tissue is ablated by eximer laser

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n Clear lens extraction
n Addition procedures
- Epikeratoplasty ? corneal surface
- Intracorneal lenses ? corneal stroma

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- Intracorneal rings ? peripheral cornea
- ICL ? Implantable collamer lens

- Piggy bag lens

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Epikeratoplasty

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Intra corneal lenses


Intracorneal lens for presbyopia

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Intracorneal rings


ICL

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Piggy bag IOL


n Relaxation procedures
- Radial Keratotomy - peripheral

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corneal stroma (6D)

- Astigmatic keratatotomy ? peripheral

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corneal stroma

Radial keratotomy

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n Coagulation ? compression procedures
- Thermokeratoplasty : peripheral cornea
(4D of hyperopia)
- Compression sutures : peripheral cornea

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Thermokeratoplasty
Myopia

n PRK ? 6D

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n LASEK- Laser epithelial keratomileusis

n LASIK ? Laser in situ keratomileusis(8-12

D)

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n Clear lens extraction

n Phakic posterior chamber contact lenses-

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ICL(Implantable Collamer surgery) - -3 to -

15D

Hypermetropia

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n PRK

n LASEK

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n LASIK ? 4D

n Conductive keratoplasty(CK)

n Intracorneal inlays

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n ICL
Astigmatism

n Limbal relaxing incisions

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n PRK ? 3D

n LASEK- 3D

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n LASIK- 5D

n TORIC IOL

n Conductive keratoplasty- 3D

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Presbyopia

n IOL- multifocal, bifocal or accomodating

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n LASER induced monovision

n LASIK- corneal multifocality

n Intracorneal inlays

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