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Cornea

Cornea Surgery in the Washington D.C. area.

Achieving good vision with cornea eye surgery

The EyeAt Visionary Eye Doctors we have special expertise in the management of corneal disorders, especially in situations where cornea transplant is needed. As a fellowship-trained corneal specialist, Dr. Martinez has extensive experience in modern cornea transplant techniques and has performed hundreds of these procedures. He has also spoken on modern cornea transplant surgery at national meetings. Dr. Martinez has performed more than 10,000 pterygiectomies and corneal surgeries combined, with a pterygium recurrence rate of 2.78%. This impressive low recurrence rate has been studied and recognized internationally, positioning Dr. Martinez as a “Top” cornea surgery doctor.

There are many conditions that can affect the clarity of the entire cornea. Sometimes corneal failure can also occur after an eye surgery, such as cataract surgery. Research done in our office shows the benefits of Pentacam® Scheimpflug Camera Technology to determine severity of corneal diseases and aid the treatment strategy. At Visionary Eye Doctors we offer an array of cornea surgery procedures, in our office-based surgery suite and state-of-the-art surgery center to treat different diseases and conditions, such as:

  • Cornea transplant
  • Anterior segment teconstruction
  • Limbal stem cell transplant
  • Lens implant exchange
  • Intacs
  • Amniotic membrane transplantation “AMT”
  • Pterygium surgery
  • Pinguecula removal
  • Lamellar keratectomy
  • Corneal tattooing

Cornea Transplant

A cornea transplant replaces diseased or scarred corneal tissue with healthy tissue from an organ donor. New technologies have made this an exciting time for corneal transplantation. Traditional corneal transplantation is a highly refined procedure with positive overall outcomes. Traditional cornea transplant techniques have evolved as well, allowing surgeons to provide even newer techniques, such as DSAEK, to patients with specific corneal needs.

There are two main types of cornea transplant: traditional, full thickness cornea transplant – PK (penetrating keratoplasty) and a partial thickness corneal transplant procedure – DSAEK (Descemet’s stripping automated endothelial keratoplasty).

DSAEK | Corneal Transplant

Traditional Corneal Transplant: PK (penetrating keratoplasty)

Traditional cornea transplant surgery has consisted of removing the entire cloudy cornea and replacing it with a full thickness donor cornea, thereby replacing all three layers of the cornea. The advantage of the traditional cornea transplant operation is the long and successful track record that we have with it. There is a 90% success rate. The rate of rejection is only about 8%. It is relatively easy to combine other surgery with it, such as treatment for cataracts or glaucoma surgery.

Transplantation involves replacing the damaged cornea with a healthy one from a donor (usually through an eye bank). Keratoplasty is a low-risk procedure – it is the most common type of cornea transplant surgery and has the highest success rate.

DSAEK (Descemet’s stripping automated endothelial keratoplasty)

DSAEK is a recently developed form of corneal transplantation in which the diseased or damaged endothelial cell lining is replaced with a new endothelial lining harvested from a donated cornea. DSAEK is an outpatient procedure that does not require hospitalization. It is generally performed using a local anesthetic and supplementary intravenous sedation.

Endothelial cells can be lost due to aging, from inherited diseases (such as Fuchs’ dystrophy), from trauma or from previous intraocular surgery. If a critical number of endothelial cells are lost, and the cornea becomes swollen and cloudy, medical therapy is usually not helpful and a cornea transplant operation is indicated.

Patients first receive a full evaluation and testing at Visionary Eye Doctors so that our ophthalmologist doctors can best determine the patient’s treatment options, including the need for DSAEK cornea surgery.

Anterior segment reconstruction

Visionary Eye Doctors surgeons have extensive experience in the medical and surgical management of standard and complex cases. They have earned national recognition for their work in the research and development of innovative techniques and instrumentation, setting the standard of care around the world in this specialty field of eye care.

Anterior segment reconstruction describes a group of techniques used to repair a defective or damaged pupil or iris or a patient with aniridia (the absence of iris tissue). This also can include simultaneous cornea transplant and/or cataract surgery. Usually, patients who require anterior segment reconstruction have suffered from a severe eye injury, infection or inflammation.

Limbal stem cell transplant

Dr. Martinez is one of the few Ophthalmologists in the country currently performing limbal stem cell transplant. He receives referrals from all over the country.

In this very specialized procedure, the limbal stem cells are taken from the healthy eye of the patient, if one exists, or a live donor – usually a sibling or a parent. (The donor eye can function with fewer limbal stem cells.) Less often, limbal stem cells are taken from a cadaver. An emerging approach uses a fraction of the amount of limbal stem cells normally taken from a live donor and grows them in the laboratory. This is an outpatient procedure, which lasts about one hour. In some cases, a limbal stem cell transplant alone can make a patient’s vision considerably better. For other patients, the limbal stem cell transplant sets the stage for what follows: a cornea transplant.

Lens implant exchange

Every day, tens of thousands of patients worldwide undergo IOL implantation. Although the overwhelming majority are performed successfully, IOLs must sometimes be removed and exchanged. Replacement occurs for a number of reasons. The most common are incorrect IOL power calculations, dislocation and decentration of the IOL, optical aberrations and damage to the lens during the insertion procedure.

Intacs

IntacsIntacs corneal implants are indicated for use in the correction of nearsightedness and astigmatism associated with keratoconus where contact lenses and eyeglasses are no longer suitable. The Intacs procedure can help a person who suffers from keratoconus to regain improved functional vision with contact lenses or ryrglasses and, in some instances, without them. Some patients, who eventually need to have cornea transplant following their Intacs procedure, may experience no complications after their Intacs are removed.

These thin, semi-circle implants are made from a material that has been safely used in contact lenses and cataract surgery for over 50 years. They are inserted into the outer edge of the cornea to create a flatter cornea shape. Flattening corneal steepness can improve vision and make the eyes more tolerant to contact lenses. Intacs cannot typically be felt or seen, as they remain below the surface of the cornea. The procedure does not require any needles or shots, only numbing drops.

Amniotic membrane transplantation (AMT)

When it comes to having an amniotic membrane transplant, there are two types of techniques used to perform the procedure. The inlay technique places the amniotic membrane graft into the corneal ulcer, then is secured by sutures without extending past the defect in the epithelial. The overlay technique involves the entire corneal surface including the limbus being covered with the amniotic membrane graft. The amniotic membrane functions as a contact lens. The transparency of the cornea will remain when the graft eventually detaches or dissolves. Both the inlay and overlay techniques may be used together for medical treatments.

Pinguecula removal

Pinguecula are a fleshy-appearing growths that are usually found on the white of the eye, most commonly on the inner corner toward the nose. Though more common in middle-aged or older people, they can be found at any age, even in young children. Most often there are no symptoms present with pinguecula and they are solely a cosmetic concern.

Many people with pinguecula are very bothered by either the appearance or discomfort from these growths and have not found relief with lubricant eyedrops. In this situation, we can perform pinguecula removal.

Lamellar keratectomy

Lamellar keratoplasty involves replacement of your damaged or diseased anterior corneal stroma (middle layer of your cornea) and Bowman’s membrane (second layer of your cornea) with donor material. Most of the bottom three layers of your cornea can be preserved. The donor corneal disc becomes repopulated with host cells, and the recipient epithelium usually covers the anterior corneal surface. Microsurgical techniques have vastly improved the technique of lamellar keratoplasty, but they have also substantially improved the results with penetrating keratoplasty.

Corneal tattooing

Visionary Eye Doctors is the only center in dc metro area that offers “corneal tattooing.” The leading reason for corneal tattooing is to cosmetically alter the appearance of the eye. Usually, the need for this alteration stems from corneal opacities. Corneal opacities (scarring of the cornea that creates an opaque or semi-transparent area on the eye) can be caused by keratitis and cataracts, among others. Tattooing the cornea can cosmetically alter the discoloration and therefore blend the opacity to a normal eye color.

For state-of-the-art cornea eye surgery, come to Visionary Eye Doctors . Residents of Rockville, Gaithersburg, Potomac, Bethesda and Silver Spring in Montgomery County, MD can call us at (301) 896-0890 or use our online Request an Appointment form to schedule your consultation.

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Phone: (301) 896-0890 | Fax: (301) 896-0968

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