Corneal Surgery

DuPage Ophthalmology is a regional referral center for corneal diseases. Our physicians are experienced in the diagnosis and treatment of corneal disorders. The cornea is a clear dome-shape structure that covers over the iris (the color part of the eye). The corneal clarity is essential for clear vision. Significant distortion of the corneal surface from scarring or pterygium can lead to profound visual loss, and in these cases corneal transplantation or pterygium removal is usually performed to restore the clarity of the cornea in order to improve vision.

Corneal transplantation

Corneal transplantation can be done in three different ways depending on the corneal pathology. If the corneal scarring is in the superficial portion of the cornea, only the front part of cornea needs to be replaced. This is call anterior lamellar keratoplasty. However, if there is significant scarring deep in the cornea or there is significant distortion to the corneal shape, then the entire, or the full thickness, of the cornea needs to be replaced. This is known as penetrating keratoplasty.

In both anterior lamellar and penetrating keratoplasties, extensive suturing is required, because the corneal wounds by nature heal slowly.The visual recovery in patients who underwent these procedures could take much time; six months to a year of recovery is not unusual.Frequently, after surgery, the patient has to wearing contact lenses in order to attain the best vision, since both of these surgical procedures can lead to significant corneal distortion, uncorrectable with glasses.

The newest method of corneal transplant is called Descemet’s membrane stripping and endothelial keratoplasty, DSEK for short.DSEK is performed in cases where the cornea is cloudy due to edema (or swelling), caused by previous eye surgery or from a hereditary disposition (such as Fuchs corneal dystrophy).In DSEK, only the inner most layer of cornea (called Descemet’s membrane) is removed and replaced with a donor cornea (called an endothelial graft).DSEK is performed though a relatively small incision, four to five millimeters, without using any sutures to hold the transplant in place.Instead, the endothelial graft is pushed against the inner surface of the host cornea by injecting air into the eye.

The advantages of DSEK include faster visual recovery, less corneal distortion, and a smaller stronger surgical wound.DuPage Ophthalmology adopted DSEK since 2005, shortly after its inception, and we have become expert in performing DSEK. DSEK is procedure of very steep learning curve and is constantly changing.We were one of the earliest adopter of DSEK in Chicago are.We approach DSEK in the same manner as we do cataract surgery - through continuous improvement, vigilant postoperative care and meticulous attention to detail.The outcomes of our DSEK patients have been excellent, and DSEK is most commonly performed corneal surgery at DuPage Ophthalmology.

Pterygium surgery

Pterygium is a corneal scar tissue that grows from the conjunctiva, a transparent mucus membrane that normally covers the sclera (the white part of eye).In most eyes, pterygium covers the nasal side of cornea.Pterygium is caused by chronic exposure to the ultraviolet portion of the sunlight.Pterygium becomes more prevalent closer we get to the Earth’s equator.

Pterygium can cause dry eye and chronic irritation of the ocular surface.With time, pterygium may enlarge, and as it approaches the center of cornea, pterygium can lead to distortion and scarring of corneal surface, causing significant loss of vision.

Pterygium is removed for three reasons:

• Chronic irritation
• Poor appearance
• Significant distortion of corneal surface

Pterygium surgery is usually performed under local anesthesia.The ptergyium and its surrounding scar tissues are removed during surgery.The defect in the conjunctiva is covered either with a conjunctival graft (harvested from elsewhere in the same eye) or an amniotic membrane (obtained from placenta), both of which help to prevent excessive inflammation and scarring post-operatively. The recovery after pterygium surgery typically takes six weeks to two months.Antibiotic and steroid eye drops or ointments are prescribed to reduce inflammation and to prevent infection.Patients with history of pterygium are advised to wear ultraviolet light-filtering sunglasses outdoor.