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PTK and Amniotic Tissue Graft

Phototherapeutic Keratectomy (PTK)

 

Phototherapeutic Keratectomy (PTK) and  Amniotic Membranes with bandage contacts play an important role in treating corneal dystrophies and keratitis.

Corneal dystrophies, such as Epithelial Basement Membrane Dystrophy (EBMD), and keratitis are serious conditions that can cause vision impairment and discomfort. However, advancements in ophthalmology have introduced innovative treatments to address these conditions effectively. This essay explores two treatment modalities: Phototherapeutic Keratectomy (PTK) for corneal dystrophies like EBMD and the utilization of amniotic membranes with bandage contacts in managing keratitis. Both approaches have shown significant efficacy in improving visual outcomes and promoting corneal healing.

Phototherapeutic Keratectomy (PTK) for Corneal Dystrophies

PTK is a minimally invasive surgical technique performed using an excimer laser. It involves removing the superficial layer of the cornea, known as the epithelium, and reshaping the underlying corneal tissue. This procedure eliminates irregularities and abnormal deposits, providing benefits for corneal dystrophies like EBMD.

PTK offers several benefits in treating EBMD. Firstly, it resolves recurrent corneal erosions by removing the irregular epithelium responsible for these erosions. This promotes better adhesion between the epithelium and underlying corneal tissue, reducing the risk of corneal erosions and associated pain and discomfort. Secondly, PTK smooths the corneal surface by eliminating irregularities and abnormal deposits in the epithelial basement membrane. This leads to a reduction in visual disturbances such as glare and blurry vision, resulting in improved visual acuity and clarity for patients.

Preoperative considerations for PTK involve comprehensive patient evaluation, including corneal topography and assessment of visual acuity. These evaluations determine the extent and severity of EBMD and assist in planning the surgical approach. Patient education is crucial to establish realistic expectations regarding visual outcomes and postoperative care.

Postoperative management include eye drops to prevent infection and reduce inflammation. Lubricating eye drops are also recommended to alleviate dryness and promote healing. Regular postoperative visits monitor corneal healing, visual acuity, and symptom improvement, with necessary adjustments to medications or further interventions based on patient progress.

Amniotic Tissue Graft

 

Amniotic Membrane Graft

Common causes of keratitis include corneal dystrophies, such as epithelial basement membrane disease (EBMD), dry eyes, exposure keratopathy, allergies, and contact lenses.  When keratitis develops prompt and appropriate treatment is needed to prevent vision loss. Amniotic membranes are derived from the placenta have gained recognition as a valuable treatment modality for keratitis. When combined with bandage contacts, they provide a protective environment for the cornea, promoting healing and improving visual outcomes.

The treatment process begins with the application of amniotic membrane directly onto the affected cornea. The membrane adheres to the corneal surface, acting as a barrier to protect the cornea and stimulate healing. A bandage contact lens, typically made of soft silicone hydrogel material, is then placed over the amniotic membrane. This lens provides additional protection, reduces friction, and enhances patient comfort.  The contact lens stays in your eye until it is removed by us.  We usually keep the contact lens in place for 3 to 7 days.  However, if it comes out before this time do not place it back into your eye.

Amniotic membranes with bandage contacts offer several benefits in the treatment of keratitis. They promote healing by releasing growth factors and cytokines that stimulate tissue repair, reduce inflammation, and inhibit scarring. Additionally, they alleviate pain and discomfort associated with keratitis by acting as a protective barrier and reducing mechanical irritation. The antimicrobial properties of amniotic membranes prevent and control infections, while their anti-inflammatory and anti-fibrotic properties minimize scarring and complications.

Conclusion

PTK and the utilization of amniotic membranes with bandage contacts represent significant advancements in the treatment.  This has become a common, non-painful, way to treat EBMD with keratitis.

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Corneal Transplants

Corneal Transplants

What is a Cornea Transplant?


A cornea transplant (keratoplasty) is a surgical procedure to replace part of your cornea with corneal tissue from a donor. Your cornea is the transparent, dome-shaped surface of your eye that accounts for a large part of your eye’s focusing power. A cornea transplant can restore vision, reduce pain and improve the appearance of a damaged or diseased cornea.

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Corneal Transplants using DSAEK and DMEK


Descemet’s stripping automated endothelial keratoplasty (DSAEK) and Descemet’s membrane endothelial keratoplasty (DMEK) are partial thickness corneal transplants which replace primarily the endothelium (innermost portion of the cornea) rather than the full thickness of the cornea (as in standard corneal transplants). DSAEK and DMEK are indicated when there is corneal clouding due to a dysfunction of the endothelium but where the other layers of the cornea remain healthy. With Fuchs’ endothelial dystrophy or when there is swelling of the cornea after cataract surgery, it is the endothelium which is compromised.

What is the endothelium and how does it work?


The cornea is the clear dome that makes up the front part of the eye. It is about 1/10th of a centimeter thick and is composed of three primary layers: the epithelium, the stroma, and the endothelium. The epithelium is a thin surface layer. The stroma is composed mostly of fibrous proteins and acts like a sponge, absorbing fluid from inside the eye. The endothelium is a single layer of cells coating the inside portion of the cornea. Its job is to provide nutrients to the cells in the stroma and to make sure that the stroma has just the right amount of fluids. Too much fluid in the stroma can cause swelling of the cornea and decreased vision.

What is endothelial failure?


The cells of the corneal endothelium are very fragile. Two of the most common causes of endothelial failure are disease (like Fuchs’ Dystrophy) and decompensation following eye surgery, cataract or glaucoma surgery. Once an endothelial cell dies, it will not grow back. If an eye loses too many endothelial cells, it is not able to maintain the proper corneal thickness and clarity.

What is DSAEK?


DSAEK is a corneal transplant technique where the unhealthy, diseased, posterior portion of a patient’s cornea is removed and replaced with healthy donor tissue obtained from an eye bank. Unlike traditional corneal transplant surgery, the DSAEK procedure utilizes a much smaller surgical incision. DSAEK usually results in more rapid visual recovery and also reduces the risk of sight threatening complications that may occur with a corneal transplant, such as intraoperative expulsive hemorrhage or post-operative traumatic wound rupture.

What is the difference between DSAEK and DMEK?


DMEK is very similar to DSAEK, except that the donor tissue implanted does not include any stromal tissue. It is a pure replacement of endothelium. This tends to give better visual results and a quicker recovery; however, donor disc dislocations and failures are more common. You should discuss both options with your surgeon to determine which is best for you.

Advantages of DSAEK and DMEK compared to full-thickness corneal transplantation, Penetrating Keratoplasty (PKP)


  • Improved vision
  • The eye surface is kept intact, thus remaining more resistant to injury and infection
  • There is minimal change in refraction because only the endothelial layer (~5% of the cornea) is replaced
  • Suture-related problems are significantly reduced/can be eliminated
  • Less risk than a traditional corneal transplant
  • Visual recovery is significantly faster and better compared to corneal transplantation
  • Less astigmatism compared to corneal transplantation
  • Reduced discomfort
  • Potential improvement in lifestyle functioning

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Dry Eye

Dry Eye

What is Dry Eye?


Dry eye occurs when your tear glands do not produce enough tears or the right type of tears. The human eye has two main types of tear glands – the lacrimal gland and the meibomian gland. The lacrimal gland is responsible for emotional crying. The meibomian gland is responsible for clear vision and keeping the eye hydrated. Dry eye disease occurs when the meibomian glands don’t work properly to create a tear film. In the early stages, the symptoms seem to appear and disappear and generally worsen as the day progresses.

Take the dry eye quiz

Dry eye disease has many possible causes, including age, gender, environment, medications, systemic diseases, and poor diet. Dry eye symptoms include the following:

  • Stinging or burning eyes
  • Pins and Needles
  • Stringy mucus in or around the eyes
  • Excessive eye irritation from smoke or wind
  • Excess tearing
  • Discomfort when wearing contact lenses

Dry eye disease is a chronic condition that can’t be cured; however, there are many treatment options available to help manage the disease. Our experienced team is equipped to administer a variety of treatment options including, Preservative Free Artificial Tears, Restasis and Xiidra.

For others, the closure of the tear drainage system with punctal plugs may be necessary. The plugs work by temporarily blocking the tear drainage channel in the inner corner of the eye, which retain more moisture in the eye.

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Diabetic Services

Diabetic Services

What Is Diabetic Retinopathy?


Unfortunately, diabetes is a common disease that can trigger a number of debilitating responses throughout our system, including the eyes. Uncontrolled blood sugar levels can damage the blood vessels in the eyes and cause vision loss or blindness. Diabetic retinopathy is an all-encompassing term which refers to the effect of Type 1 or Type 2 diabetes on the eyes. To properly diagnose this serious disease, we use common procedures to detect blood flow to the retina. We then use high-resolution photographs of the retina to understand what kind of diabetic retinopathy is occurring.

Many diabetic patients can have diabetic retinopathy without knowing it. Usually, there is no pain and no outward sign. Over time, you may notice gradual blurring or some vision loss. Symptoms may come and go. If diabetic retinopathy is severe, you may have clouded vision or blindness. You should have regular eye exams to help your doctor detect changes in your vision. Treatment may help slow the progress of diabetic retinopathy and sometimes can restore lost vision. Treatment depends on your condition. 

Fortunately, diabetic retinopathy is preventable. People with diabetes are most susceptible to developing it. The better you control your blood levels, the lower your risk. Laser Eye Surgery encourages you to take prevention seriously by scheduling yearly eye exams.

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Types of Diabetic Retinopathy


Non-Proliferative Diabetic Retinopathy


This type of diabetic retinopathy can occur after several years of being diabetic. The disease causes the retina to develop spots from minor blood leaks and dilated vessels. This can cause swelling if it escapes into the main portion of the retina. If it remains untreated, further damage is likely and will lead to vision loss. The onset of this can occur with or without symptoms. Some symptoms include floaters, double vision or blurring.

Proliferative Diabetic Retinopathy


When diabetes has been present for several years, problems with the retina can develop. While the exact cause of diabetic retinopathy is not known, it appears that elevated blood sugar levels can cause damage to the blood vessels and red blood cells, reducing circulation to the retina. 

Proliferative diabetic retinopathy is a rare form of retinopathy and causes a significant loss of vision. Once it has progressed, it causes a network of blood vessels to grow over the retina. Retinal detachment can occur, causing a sudden loss of vision. Vessels in the eye tend to bleed easily, damaging eye tissue.

Treatment Options for Diabetic Retinopathy


Treatment options can include different forms of laser surgery to surgical blood removal, therapeutic injections, and repair of the retina.  There are several approaches your doctor may use which in eye injections, laser treatment, focal laser photocoagulation, pan retinal photocoagulation, and vitrectomy surgery.

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Macular Degeneration

Macular Degeneration

What is Macular Degeneration?


Age-related macular degeneration (AMD) is a deterioration or breakdown of the eye’s macula. The macula is a small area in the retina — the light-sensitive tissue lining the back of the eye. The macula is the part of the retina that is responsible for your central vision, allowing you to see fine details clearly.

Symptoms associated with age-related macular degeneration include:

  • A gradual loss of ability to see objects clearly
  • A gradual loss of color vision
  • Distorted vision
  • A dark or empty area appearing in the center of the vision

Vision loss is usually gradual, patients who develop macular degeneration must carefully and constantly monitor their central vision. Our experienced team is equipped to administer specialized treatments and care. Regular exams are the best way to detect the disease and inform your ophthalmologist of any vision changes. 

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Types of macular degeneration


Dry Macular Degeneration


Dry macular degeneration is the most common form. In its early stages, the thinning and aging of the macula will lead to excess pigment development which collects in small deposits in the tissues of the eye. Patients in their early to mid stages of dry macular degeneration may have blind spots in the center of their vision. In advanced stages, patients may lose their central vision completely. Advanced dry AMD is also known as geographic atrophy.

There is some good news for patients with AMD and geographic atrophy.  A new injection for eyes with geographic atrophy has been approved as of February 2023 called Pegcetacoplan (Syfovre®).  This injection targets the “Complement System.”   The injection specifically targets the complement factor C3.  This blocks the inflammatory cascade which can ultimately damage your macula and cause decreased or poor vision.  Pegcetacoplan (Syfovre®) injection is recommended to be given every one to two months.  Insurance approval is pending and some insurances will take longer for approval than others.

For more information regarding Pegcetacoplan (Syfovre®) go to https://syfovre.com/

Wet Macular Degeneration


Wet macular degeneration occurs when abnormal blood vessels begin to grow and form in the eye, causing blood and fluid to leak out and damage the cells in the retina which respond to light.  Vision loss from this form of macular degeneration may be faster and more noticeable than that from dry macular degeneration.

The longer these abnormal vessels leak or grow, the more risk you have of losing more of your detailed vision. If abnormal blood vessel growth happens in one eye, there is a risk that it will occur in the other eye. The earlier that wet macular degeneration is diagnosed and treated, the better chance you have of preserving your central vision.

Treatment for Wet Macular Degeneration


For some patients, a laser procedure may be used to treat their wet macular degeneration. For most, injections will be recommended.

Avastin®, Eylea®, Lucentis®, and Vabysmo® are intravitreal injections given to treat wet macular degeneration.  These medications have helped millions of patients worldwide.  Early and consistent injections can help prevent vision loss.  These injections will need to be repeated every one to two months.

For more information regarding Avastin® for the treatment of wet age-related macular degeneration, visit http://www.nih.gov/news/health/apr2012/nei-30a.htm.

For more information regarding Eylea® for the treatment of wet age-related macular degeneration, visit http://www.eylea.us.

For more information regarding Lucentis® for the treatment of wet age-related macular degeneration, visit http://www.lucentis.com.

For more information regarding Vabysmo® for the treatment of wet age-related macular degeneration, visit http://www.vabysmo.com

 

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