The Future of Eye Surgery: Glue?
Keratoconus is an abnormal, gradual thinning of the cornea which, if left untreated, can lead to significant loss of vision, poor visual acuity and other eye sight problems. Conventionally, the condition has been frequently treated by corneal transplant surgery. However, quite recently, a new advancement in the field of corneal transplant surgery was introduced by an American eye doctor that is now being called by many experts as the possible future of eye surgery. This article focuses on the basics of the keratoconus and the promising role of the same glue-based corneal transplant surgery to treat the condition.
Progression of Keratoconus
Keratoconus is a progressive eye disorder, i.e. it develops gradually, over a long period of time. In the beginning, the central portion of the cornea begins to weaken which leads to an abnormal or irregular shape of the cornea. These weakened areas protrude outward and the optical figure of the cornea deviates from the normal shape. Some serious complications of keratoconus include perforation of the cornea and scarring and, eventually, vision loss.
Corneal transplant surgery and how can it be used to treat keratoconus?
It should be noted that the poor visual acuity associated with Keratoconus cannot be improved satisfactorily by regular glasses or contacts lenses. In such complicated cases, a corneal transplant may be essential to replace the abnormally shaped or injured cornea with a healthy, clear cornea to restore good vision and visual acuity. In corneal transplant surgery the scarred or damaged cornea in the recipient’s (patient’s) eye is removed and replaced by a human donor (other person’s )cornea called a graft. Corneal transplant surgery is also called as penetrating keratoplasty or corneal grafting. In otherwise routine cases, this surgery does not involve the use of glue.
Dr. Reilly’s "glue-based" corneal transplant
Dr. Reilly, an experienced eye surgeon from Lakeland recently performed a unique corneal transplant surgery that surprised the whole world of eye care. In the first-of-its-kind surgery, Lt. Col. (Dr.) Reilly was able to perform a partial cornea transplant using a type of glue to correct a thinning cornea. This procedure was performed on a patient who had a full corneal transplant in the 1980s due to Keratoconus. However, despite the treatment, the disease progressed over the years, eventually leading to the thinning of the corneal tissue. This led to significantly reduced vision, also impairing the quality of life of the patient. As the patient did not want to undergo a full corneal transplant again, Dr. Reilly had to perform a partial corneal graft. As the software was not originally designed for a partial graft, Dr. Reilly had to specifically design the laser for the cut.
Dr. Reilly first made the exactly similar cuts in both the patient’s eye and the donor’s eye and then applied the glue over the part of the cornea he did not want to laser, covering it.
While the use of cyanoacylate glue is frequent in corneal surgery, this was a unique application in a sense that, for the first time, the glue was used to shield the cornea only partially so that the laser could be avoided. The surgery was successful and the patient noticed significant improvement in the vision and his quality of life.
Other recent examples of glue use in eye surgery
In addition, the specific type of glue has been successfully used in some other cases such as during a cataract surgery to help fit the intraocular lens.
An intraocular lens, commonly known as IOL, is a small, lightweight, clear-plastic disk which is placed in the eye during surgery to replace the eye’s natural lens in a number of conditions such as:
- During a cataract’s surgery
- To correct short sightedness (myopia)
- To correct fat sightedness (hyperopia)
- To correct astigmatism
Unlike contact lenses, which must be worn & removed on daily basis for cleaning, intraocular lenses are permanent and do not require regular maintenance. Also, unlike cataract glasses which magnify images, an IOL produces a normal-sized and shaped image on the retina, replacing the focusing power of the natural lens more closely than either cataract glasses or contact lenses.
Use of glue during IOL surgeries in India
In July 2008, for the first time ever, eye tissue glue was used to fix an intraocular lens in the eye of a four year old girl in India. As a result, her vision was successfully restored. Since then, the tissue glue has been successfully used in India and the technique called “tissue-glue” technique or glued-IOL surgery has helped numerous patients restore or improve vision and quality of life. The glue used in such procedures is usually fibrin (substance present in human blood plasma) or tissue glue made from serum which also has a frequent use in urological and plastic surgeries. As this glue is made of human tissues, there have been no reported side effects. This “glue technique” basically utilizes glue to fix the IOL in the eyes so that it would not move here and there. Accordingly, the technique is also particularly useful in those patients who have poor support of the natural eye lens due to some trauma, hereditary problems or structural defect. While in regular surgeries nothing could be done to correct this problem, glued-IOL surgery does solve the issue in people whose intra-ocular lens capsule is absent.
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