LASER VISION CORRECTION | OPTICAL DEPARTMENT ....... Charlotte (704) 364-7400 ........Huntersville (704) 895-8200

CORNEAL DISEASE

The cornea is the clear part of the front of the eye. It is the part of the eye on which people put contact lenses.  It is similar to a watch crystal in that it is normally clear and allows light to pass through it without any problems.  However, in the presence of corneal disease the cornea can become cloudy and tend to scatter the light resulting in less than normal vision.  There are many forms of corneal disease but the ones that are most common are keratoconus, Fuchs’ dystrophy, bullous keratopathy.

Keratoconus is a condition in which the fibers that make up the bulk of the cornea are inherently weak.  These fibers are responsible for keeping the cornea well-organized and transparent.  When the fibers are weak, as in keratoconus, the cornea begins to thin and deviate from its normal curvature assuming an irregular cone-like shape.  This condition is usually present in both eyes though one eye may be more advanced than the other.  Vision is usually corrected with glasses or contacts in the early stages of keratoconus. In advanced cases, a hard contact lens (RGP) or surgery (corneal transplant) may be necessary to restore vision.  In certain situations in which the keratoconus is progressing quickly a novel treatment called corneal crosslinking may be an option.  Corneal crosslinking has not yet been approved by the FDA but has shown promise in European studies to help strengthen the cornea.

Fuchs’ dystrophy is an inherited condition that can eventually lead to corneal swelling (edema).  In Fuchs’, the inner layer of the cornea, called the endothelium, begins to get small bumps called guttae and loses its ability to pump fluid out of the cornea. As a result of the dysfunctional endothelium, the cornea begins to accumulate fluid and swell.  When the cornea accumulates enough fluid it starts to interfere with vision. It can seem like you are looking through a steamy bathroom window.  This cloudy vision usually appears upon awakening and will become clearer as the day progresses. When the quality of vision is poor enough surgical intervention is recommended.  Historically, a full thickness corneal transplant has been performed to replace the diseased endothelial layer.  However, recent advances in surgical techniques have allowed ophthalmologists to remove only the endothelial layer and replace it with a donor layer. This new technique is called DSEK or DSAEK which stands for Descemets Stripping, (automated) Endothelial Keratoplasty.  DSEK has multiple advantages over a traditional corneal transplant including quicker visual recovery and better stability of the wound.  Dr. Whiteside, our corneal specialist, has been performing DSEK for a few years and would welcome the opportunity to discuss surgery with you.

Bullous keratopathy is another condition that results in corneal edema.  Bullous keratopathy results when the inner layer of the cornea, the endothelium has been damaged and there are not enough cells remaining to pump the fluid out of the cornea. These cells are usually lost or damaged as a consequence of trauma or surgery.  The result is corneal edema.  This usually begins with fluid filled microcysts in the superficial layer of the cornea called epithelium.  Eventually, these microcysts unite or coalesce to form a larger cyst called bulla.  Vision will be poor due to the corneal swelling and bullae.   These large cysts can rupture causing intense pain much like a corneal abrasion. Surgical intervention is generally recommended when vision is blurry or when it becomes painful, depending on the potential for useful vision of the eye.  If no other eye disease is present the patient may do well with DSEK (see above).  If the retina or optic nerve have sustained significant trauma other procedures may more beneficial.  Dr. Whiteside will discuss with you which surgery would be most useful for your situation.

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