Cornea and Anterior Segment

The Cornea and Anterior Segment unit at LVPEI has treated patients from all over India and the neighboring countries. It specializes in the treatment of the entire range of corneal disorders and infections. This unit has set a record of sorts by performing more than 1000 corneal transplants in a single calendar year (2003), using corneas harvested by LVPEI's Eye Bank. The Eye Bank also distributes corneas to hospitals in Hyderabad and other places.

Apart from cataract surgery and corneal transplants, clinicians in this service handle a range of other ocular complications, from infections on the surface of the eye and eyelids to trauma care. Clinicians also work closely with scientists at the institute to develop new and more cost-effective treatments. Among the several research projects at the Institute is the stem cell research program, which has made possible an innovative treatment procedure for persons with ocular surface damage.

Ophthalmologists at LVPEI have expertise and experience in laser assisted surgical procedures. The Institute has been providing laser assisted refractive surgeries for many years with extremely successful results. Recently the Wavefront Assisted Customized Vision Correction Technology was added to the list of corneal services. This new equipment from Bausch & Lomb enables patients to benefit from the latest advancements in refractive eye surgery.

Corneal Transplant

The cornea is the front, outermost layer of the eye. Just as a window lets light into a room, the cornea lets light into the eye. It also focuses the light passing through it to make images clear and sharp.

Corneal problems can occur in anyone regardless of age. Sometimes due to disease, injury or infection the cornea becomes cloudy or warped. A damaged cornea, like a frosted or misshapen windowpane, distorts light as it enters the eye. This not only causes distortion in vision, it may also cause pain.

When there is no other remedy, doctors advise a corneal transplant. In this procedure an ophthalmologist surgically replaces the diseased cornea with a healthy one to restore clear vision.

Contact Lens Centre

Among the specialized lenses provided by The centre are ROSE K contact lenses for patients with keratoconus. These specialized lenses are meant for patients who are unable to adjust to RGP contact lenses.

Fitting of imported scleral contact lenses is a new service that has been added to the contact lens Centre. These lenses are meant for patients with severe forms of corneal ectasia, advanced keratoconus, and keratoglobus pellucid marginal degeneration. Routine corneal contact lenses cannot be fitted on these patients' eyes.

Also see the B&L Contact Lens Centre

Ocular Surface Services

A 'dry eye' is a condition where patients suffer from irritation and discomfort in the eye because of the decreased quantity of tears or increased evaporation of tears from the eye. The symptoms are non-specific and can range from a tired or itching eye to diminished vision in severe cases. A clinical examination can help diagnose a condition of 'dry eyes' but, to be more definitive, diagnostic tests are required.

As part of our ocular surface service, patients with dry eyes undergo a detailed examination to assess the severity of the problem and other complications. Some patients may have extensive ocular surface damage. The treatment includes use of preservative-free artificial tears, autologous serum and topical immunosuppresive treatment.

Dry eyes can also be a manifestation of systemic diseases like rheumatoid arthiritis. A blood examination could help identify the disease, which can then be jointly treated by the ophthalmologist and rheumatologist. Patients who have such symptoms are advised procedures to preserve tears through implantation of silicone punctal plugs or cauterising the puncta (tear glands).

Patients suffering from ocular discomfort and dysfunction, or damaged stem cells in the eye, resulting in scarring and new blood vessel formation, have a very unstable ocular surface. For some cases, stem cell transplantation can provide a solution. Doctors at LVPEI were among the first in the world to perform this procedure, in cases of chemical injury and deep scleral ulcers.

Stem Cell Transplantation

Patients with severe ocular surface damage are advised to undergo limbal stem cell transplantation for the restoration of the ocular surface and the improvement of visual acuity. For patients with severe ocular surface damage and dry eyes, limbal transplantation is not an option; keratoprosthesis is the only solution. Though keratoprosthesis is a laborious procedure, the results can be rewarding.

With over two years of research and clinical application, the stem cell team headed by Dr Virender Sangwan and Dr Geeta K Vemuganti has treated 700 patients with a high rate of success. In addition to transplantation of the cultured epithelial (stem cell) tissue in the limbus, 18 patients have also undergone corneal transplants.

In certain extreme cases, LVPEI's scientists and ophthalmologists felt the need for culturing another area of the ocular surface epithelium, called the conjunctiva. They were successful not only in cultivating the conjunctival epithelium for clinical use, but in also generating a new model of 'composite culture,' or a 'co-culture' consisting of the central corneal epithelium and the peripheral conjunctival epithelium, as seen naturally in the eye. These co-cultures have been generated by the use of a self-designed ring barrier. Initial results from the clinical use of 'co-culture' in patients have been very encouraging, long-term results are awaited. This development received a great deal of attention when a paper on it was presented at the Association for Research in Vision and Ophthalmology (ARVO) in Florida, USA.

Corneal Dystrophies

Corneal dystrophies are inherited conditions where patients develop bilateral and symmetrical corneal opacities commonly involving the central cornea. This condition can cause a decrease in vision, as well as symptoms of irritation and watering. Studies done in the Institute have helped us to understand the disease process better. Studies aimed at identifying mutations in the BIGH3 gene, the cause of diseases like Lattice, Granular and Reis-Bucklers dystrophies, have resulted in the identification of some mutations that are common to different populations, as well as some novel mutations. The other common dystrophy that causes significant visual impairment requiring corneal grafting is Macular Corneal Dystrophy (MCD). Studies on 37 patients with MCD have revealed several new mutations in the carbohydrate sulphotransferase gene. Genetic research is being conducted to find the mutation in the more difficult cases.