Best Corneal Transplant Surgeon In The World

Best Corneal Transplant Surgeon In The World – Cataract surgery in eyes with a first corneal transplant is very difficult and there are complications that can alter the postoperative visual outcome. The first challenge is to get an accurate estimate of IOL power. The new cornea may be at least slightly irregular, and in this case there is a long axial length of high myopia. Aiming for a postoperative myopic result of at least one or two diopters is a good idea. Remember that it always benefits mild myopia but almost never benefits postoperative hyperopia. This patient can return to hard contact lenses after recovering from cataract surgery to achieve optimal vision.

We can also measure the health and condition of the donor’s corneal tissue by counting endothelial cells or by examining corneal pachymetry. Having a pachymetry of less than 600 microns is a good indicator of progression, while a pachymetry of more than 650 microns means that there is a high risk of corneal failure even after complete cataract surgery. When performing cataract surgery, using a good spreading viscoelastic, working away from the corneal endothelium, and using low power water/phaco will all help to achieve a clear cornea after surgery.

Best Corneal Transplant Surgeon In The World

During surgery, we need to use a low infusion pressure to avoid putting pressure on the corneal graft-host tissue junction. Finally, assessment of the graft-host union at the end of surgery can help identify any leaks that require drainage. In the postoperative period, be sure to use an adequate steroid regimen to reduce inflammation and reduce the risk of failure or rejection.

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Our patient had a good outcome with a clear cornea on postoperative day #1. We also chose to place a 10-0 nylon wound to close the phaco box.

Professor Uday Devgan MD is a cataract surgeon from Los Angeles who is the author of teaching best practices in cataract surgery to eye doctors around the world. View all posts by Uday Devgan MDT My two favorite things are eye surgery and teaching. Although I do both at home in Los Angeles, there is something unique about teaching ophthalmology abroad. While teaching corneal transplants abroad, I am well aware of how fortunate I am to live in a time and place that makes my work as a corneal surgeon possible. Mongolia is no different from other countries I have visited: eye care is advanced enough that modern cataract surgery is available, but corneal transplants are impossible due to the lack of donor corneas. Compare this to my daily life at home: one of my patients has to wait for a donor, and I send my choice of corneal cells the day before surgery. In Mongolia, there are no fellowship programs in ophthalmology. The only way an ophthalmologist can train specifically in eye care is to leave the country. This means that we have a lot to learn here in a short time.

We have imported donor corneas for shipment from the United States, generously donated by Sightlife eye bank. In the past two days, we have performed 6 corneal transplants. I transplanted the first organ to a blind patient who had an accident and was left with a scar. During the operation, I always explained in detail to the team of doctors around the screen behind me, with the microscope we were using, it was presented by Karl Storz. We use surgical instruments and equipment supplied or sponsored by See International, Alcon, Moria and Katena. After leaving the OR, we shiver in the doctor’s room (trust me, this never happens at home)! Apparently, this was the first time a corneal transplant was performed at the First National Hospital and the doctors had never seen a corneal transplant before.

Dr. Narantsetseg Oyungerel (by Dr. Nara) did 50% of the following case on a young man with corneal scarring from keratoconus, a condition that causes the cornea to deform. He did 90% of another case for a guy who suffered a corneal injury while repairing his car. The next day, Dr. Nara did it herself, with the help and guidance of Laura. He did an excellent job and I was very impressed that he learned the surgery so quickly!

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The story of the patient below saddens me. I hope that as you read this, you will take a moment to think about what your life would be like today if you were born blind and there was no treatment to help you see. On our first day, a 3-month-old child whose mother brought him to the field to see us. He was born with a rare condition called sclerocornea, which causes the cornea to become opaque at birth. My heart sinks into my chest when I look at this baby. I felt disabled, without all the possibilities at home. The cards were stacked against this child: we didn’t have the right cases for a pediatric case, there was no anesthesiologist at this hospital, and he would need intensive care that was not available in the countryside. But if we do nothing, these children will not have the chance to see or live a normal life. Time is important for him; any further delay will result in severe amblyopia (the inability of the child’s brain to learn to see clearly). The team moved heaven and earth to make arrangements for this baby’s surgery and follow-up care. The room was quiet during the operation and I felt like I was breathing the whole time. Laura and I sometimes used the instruments we had. I’m glad everything went better than I expected. This is far from the end of the road for this baby and his family. At least now he has a chance to see, a chance he wouldn’t have had otherwise. For many years, penetrating keratoplasty was the go-to method for corneal transplantation. Then came disease-based techniques—endothelial and lamellar keratoplasty—which replaced the traditional “one-stage” approach to PK with surgical techniques that increasingly refined their indications. The number of endothelial transplants exceeded that of full thickness around 2012.

But this process does not mean that penetrating keratoplasty is lost; PK is more or less high than before. Here, experts discuss the changing state of keratoplasty techniques, concerns about thick transplants, and whether full-penetration keratoplasty is still necessary.

The Eye Bank of America reported in 2019 that the number of referred keratoplasty grafts increased by 0.4 percent (to 17,409 grafts) and endothelial keratoplasty increased by 1 percent (to 30,650 grafts), mainly due to an increase in the percentage 23 in DMEK procedures.

Thomas John, MD, assistant professor of medicine at Loyola University Chicago, and in private practice in Oak Brook, Tinley Park and Oak Lawn, Illinois, says: “This almost doubles the number of penetrative keratoplasty. “What happened when “From for a long time we had only one option: PK, and now we have advanced methods to choose a corneal transplant for lamellar or endothelial keratoplasty.”

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Kenneth R. Kenyon, MD, professor of ophthalmology at Tufts University School of Medicine/New England Eye Center and a member of the Harvard School of Medicine and Schepens faculty member says: “Just 15 years ago, keratoplasty was almost exclusively keratoplasty. .” Eye Research Institute. . “Then there was a revolution, as both early and late lamellar procedures were designed to manage specific corneal problems. Now, in the United States, endothelial keratoplasty (DSAEK or DMEK) accounts for at least 50 percent of keratoplasty.

“Anterior lamellar keratoplasty also has an additional role for corneas with healthy, functional endothelium, especially for keratoconus and stromal lesions from trauma and bacterial keratitis,” said Dr. Kenyon. “Especially in developing countries where these conditions are very common and corneal donor cells are always available, ALK has the advantage that it does not eliminate and does not require the highest quality of corneal donors. About 25 percent of transplants use techniques ALK is used.” “

Christopher J. Rapuano, MD, of Wills Eye Hospital, Philadelphia, adds that anterior lamellar grafts have been around for decades alongside penetrative grafts, “but they’ve been used very little.” for a long time, because the methods and results do not work. in charge. well When the big bubble method came out, we started to do more DALKs, which is a better method than PK, the main advantage is that there is no endothelial rejection. That said, it is a complicated process and many people believe that the visual results are not as good as PK.

PK accounts for 30 percent of cases, according to Dr. Kenyon. “These cases have a combination of stromal scars, inflammation, injury, or stimulation that is not amenable to DALK and is often accompanied by endothelial failure, which requires more than DSAEK.

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Adjacent keratoplasty still has a role to play, though

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