Cornea /Keratoconus

Ignoring a cornea disease may lead to permanent loss of vision. Therefore, early diagnosis and the correct treatment are important.

The cornea is a transparent layer in the front part of the eye which focuses the light and protects the eye from external agents, and thus plays an important role in the visual process. A number of diseases have a negative impact on the cornea’s transparency. They may be congenital and have genetic roots or be viral. Some diseases such as keratoconus are very serious because they change the shape of the cornea and require a cornea transplant.

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Frequently Seen Cornea Diseases

Keratitis: Cornea inflammation

Keratoconus: An advancing disease characterised by thinning and liquefaction of the cornea

Dry eye syndrome/keratoconjunctivitis sicca: The condition of having dry eyes

Cornea erosion: Damage due to cutting, grazing or scratching of the cornea surface.

C3R for Keratoconus

What is Keratoconus?

Keratoconus is a progressive eye disease in which the normally round cornea thins and begins to bulge into a cone-like shape. This cone shape deflects light as it enters the eye on its way to the light-sensitive retina , causing distorted vision and is often not satisfactorily corrected with glasses. Glare and light sensitivity also may occur. Often, keratoconic patients experience changes in their eye glasses prescription every time they visit their eye doctor. The Normal Cornea The eye is like a camera in which lenses focus the picture on a light sensitive film. In the human eye, the transparent cornea and lens focus light on the retina, which changes it into electrical signals, which are then transmitted to the brain by the optic nerve to be perceived as images.

What Causes Keratoconus?

New research suggests the weakening of the corneal tissue that leads to keratoconus may be due to an imbalance of enzymes within the cornea. This imbalance makes the cornea more susceptible to oxidative damage from compounds called free radicals, causing it to weaken and bulge forward. Risk factors for oxidative damage and weakening of the cornea include a genetic predisposition, overexposure to ultraviolet rays from the sun, excessive eye rubbing and chronic eye irritation.

Keratoconus Treatment

In the mildest form of keratoconus, eyeglasses or soft contact lenses may help. But as the disease progresses and the cornea thins and becomes increasingly more irregular in shape, glasses and regular soft contact lens designs no longer provide adequate vision correction.

Treatments for Progressive Keratoconus Include

Corneal cross-linking (CXL)
Custom soft contact lenses
Gas permeable contact lenses • “Piggybacking” contact lenses
Hybrid contact lenses
Scleral and semi-scleral lenses
Intacs
Topography-guided conductive keratoplasty
Corneal transplant Corneal crosslinking.

This procedure, also called corneal collagen cross-linking or CXL, strengthens corneal tissue to halt bulging of the eye’s surface in keratoconus. The aim of this treatment is to create additional chemical bonds inside the corneal stroma by means of a highly localized photo polymerization. The indications for cross linking today are corneal ectasia the disorders such as keratoconus and pellucid marginal degeneration, iatrogenic keratectasia after refractive lamellar surgery and corneal melting that is not responding to conventional therapy.

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The Principle of C3R (Corneal Collagen Cross-Linking)

Photo-polymerization using UV-light was found to be the most promising technique to achieve cross-links in connective tissue. Photo-polymerization is activated by means of a non-toxic and soluble photo mediator and a wavelength which is absorbed strongly enough to protect deeper layers of the eye (riboflavin-UVA technique).

UV-A radiation with concomitant administration of riboflavin solution leads to physical cross linking of the corneal collagen fibers. Thus progressive corneal thinning is slowed down or even stopped and the Biomechanical strength of corneal tissue is improved.

The Device for C3R

For C3R we need riboflavin dye and a special device called cross-linker. Cross linker is a device to deliver UV-A light of specific wavelength of 365 nm , at a controlled energy level of 3 mW/cm.sq.

The C3R Procedure

After removal of the corneal epithelium, riboflavin solution is instilled for 30 minutes on to the cornea. Then the corneal penetration of this is checked by establishing that the anterior chamber is slightly yellow. Pachymetry is performed to make sure that minimum corneal

thickness is maintained. UV-A radiation starts under continued administration of Riboflavin Solution. After 30 minutes of radiation treatment is finished and the patient receives post-operative treatment like after a PRK procedure. A bandage contact lens is inserted in the operated eye and the patient is administered oral and topical antibiotics, steroids, anti-inflammatory medication as well as lubricant eye drops.

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Dr. Neeraj

Specialist: Ophthalmologist
Experience: 31+ years of experience
Hospital: Viaan eye and retina centre

More about Dr. Neeraj

Dr. Neeraj Sanduja is a reputed eye specialist with 18 years of rich experience as a Vitreoretinal Consultant. Dr. Sanduja completed his MBBS degree from PGIMs Rohtak and MS in ophthalmology from the same institute. Currently, Dr. Sanduja works as a Senior Consultant-Ophthalmology (Vitreoretinal) in Paras Hospitals, Gurgaon. His previous experience includes a stint at William Beaumont Hospital, Michigan, the USA as a Visiting Fellow in Paediatric Retina.
Dr. Sanduja has been involved in the organisation of various national and international conferences on subjects such as Diabetic Retinopathy, AMD and Retinopathy of Prematurity. Dr. Sanduja has always excelled in his profession as well as academics. He has multiple fellowships like FICO (UK), FRCS (Glasgow) & FAICO (Retina). He was awarded the Best Ophthalmologist in Delhi/NCR (2015) by the IMA. He has published numerous papers in various national and international publications. His area of expertise includes Vitreoretinal Laser Surgery, Disease of Retina and UVEA, Diabetic Retinopathy, Retinal Detachment, Ocular Trauma, Retinopathy and Macular Hole. Read More

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Viaan Eye & Retina Centre

Airport Distance: 20 kms from Indira Gandhi International Airport, New Delhi.
Location – Plot No. – 2227, Near, Wazirabad Rd, Wazirabad, Sector 57, Gurugram, Haryana 122011

Brief about Hospital:

Discover Excellence in Eye Care:

At Viaan Eye & Retina Centre, we take pride in being recognized as the best eye hospital in Gurgaon. Our commitment is to deliver state-of-the-art diagnostic and therapeutic services across all ophthalmic subspecialties. With a focus on utilizing cutting-edge technology and combining it with the expertise of our skilled professionals, we ensure the highest standards of eye care.

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What sets us apart is our guiding philosophy – to provide ethical eye care by integrating the latest technology with human intelligence. We believe in delivering not just routine eye-care services but also advanced diagnostic and therapeutic solutions for vitreous and retinal diseases. Our expertise extends to performing Phacoemulsification surgery for Cataracts, showcasing our dedication to comprehensive eye care. Read More

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