Laser and refractive surgery

• Myopia
• Hyperopia
• Astigmatism

Corneal problems 

• Keratoconus
• Fuchs dystrophy
• Infections/keratitis
• Recurrent Corneal Epithelial Erosion
• Corneal injuries
• Corneal scars
• Corneal dystrophies

Cataract

Pterygium

Ocular surface problems 

• Dry eye
• Blepharitis
• Rosacea

Ocular surface tumours

• Ocular surface squamous neoplasia
• Conjunctival melanoma

Laser and Refractive Surgery

• LASIK, PRK, PTK
• Phakic intraocular lens implantation (phakic IOL, ICL)
• Clear lens extraction/refractive lens exchange

Keratoconus Management

• Collagen cross-linking
• Kerarings
• Topography-guided PRK

Corneal Transplantation

• Endothelial keratoplasty
• DSAEK
• DMEK
• DALK

Cataract Surgery

Pterygium Surgery

Excision of Ocular Surface Tumours

PTK for recurrent corneal epithelial erosion and corneal scars

Keratoconus is a degenerative process affecting the cornea, the clear window of the front of the eye, distorting it out of shape and interfering with the focus of the eye. The cornea becomes more conical in shape and this makes vision blurry by making the eye more short-sighted (myopic) and also distorts vision by producing irregular astigmatism (the cornea is not evenly curved). The condition usually affects both eyes but one may be much worse than the other.

Keratoconus is a genetically determined condition but is not necessarily passed on in families. One in twelve people with keratoconus will have an affected relative. If there is not a definite family history then there is a one in ten chance of the children of someone with keratoconus also having it.

Keratoconus is often associated with allergic disorders such as asthma, eczema and hayfever. It is more common in those with Down’s syndrome. It is also more common in people with sleep apnoea syndrome or floppy eyelid syndrome.

There are a number of options for dealing with keratoconus:

• Nothing may be necessary in very mild cases or if vision is good in one eye.
• Glasses my help if the cornea is not too distorted.
• The most helpful option is wearing contact lenses. These will generally need to be rigid gas-permeable (RGP, hard) lenses. This is the quickest way of getting good vision.
• If he condition is progressing then Collagen Cross-Linking is advised to stabilise the cornea and prevent further progression
• Intrastromal Corneal Ring Segments (Kerarings) can be used to reduce the distortion of the cornea and improve unaided vision and vision with glasses or contact lenses
• Laser treatment (topography-guided PRK) may be used to further improve vision
• Phakic intraocular lens implantation (phakic IOL, ICL) may be used to reduce high levels of myopia after other procedures have improved vision with glasses
• Corneal transplantation may be required for those who have poor vision even with contact lenses, or who are unable to wear contact lenses.

Corneal transplantation is replacement of part of the cornea with human tissue from deceased donors. These are proper transplant procedures with the potential risks associated with that. Satisfactory synthetic grafts are not yet routinely available. Keratoprosthesis (artificial cornea) procedures may be done when standard corneal transplants fail repeatedly or have no hope of surviving and working.

Corneal transplantation is performed for several reasons:

• Optical replacement of the cornea: The most obvious reason for replacing the cornea is to improve vision where the cornea is opaque, scarred or distorted out of shape.
• Tectonic grafts: A tectonic corneal graft is done to restore structural integrity of the eye when there is ulceration or perforation of the cornea.
• Therapeutic corneal grafts: These are done where there is infection of the cornea that is not controlled by use of antibiotic or anti fungal therapy and the affected part of the cornea needs to be removed.
• Pain: Some corneal conditions, such as bullous keratopathy, are painful and corneal transplantation may be performed to keep the eye comfortable even when it is not expected that vision will improve.

Types of corneal transplants

The traditional method of corneal transplantation has been full thickness transplantation (Penetrating Keratoplasty (PK). This is not a new technique, with the first successful corneal graft being reported in 1905.

More recently there has been a shift to replacement of only the affected layers of the cornea (Lamellar Keratoplasty, LK), including Deep Anterior Lamellar Keratoplasty (DALK) for the front of the cornea and Endothelial Keratoplasty (EK, DSEK, DSAEK, DMEK) for replacement of the posterior layer of the cornea – the corneal endothelium.

For more information please click here.

Corneas are donated after death and are processed in the Lions Eye Bank of Western Australia at the Lions Eye Institute. Corneas need to be obtained within 24 hours of death and consent from the next of kin needs to be available within that time even if the deceased has registered as an organ donor. Registration as a donor and discussion of your wishes with next of kin is important if you do wish to donate organs or tissues after death.

To register as an organ and tissue donor see:

https://www.humanservices.gov.au/individuals/services/medicare/australian-organ-donor-register

The corneas have a number of testing procedures performed and must be used within 4 weeks of donation. We are fortunate to usually have enough donors in Western Australia to be able to schedule corneal transplants within several weeks and also deal with emergency cases. Occasionally corneas need to be obtained from other eye banks around Australia or New Zealand.