Ask A Doctor Appointment
Sankara Nethralaya
Sankara Nethralaya
Home About Us Patient Care Education Research LASIK Donate Now Career Contact Us



Specialities

Cornea

Brief History

The C J Shah Cornea Services at Sankara Nethralaya, established in 1978 and presently headed by Dr. Rama Rajagopal, is a centre dedicated to the management of corneal disorders. The department consists of 13 well-trained corneal surgeons including Chennai and Kolkatta. The departments are well equipped with instrumentation and technology to provide state-of-the-art care for patients suffering from a wide variety of corneal disorders. The departments have an elaborate academic and surgical training programme for fellows in cornea and external eye diseases. Research programme encompasses both basic and clinical work involving corneal diseases and transplantation. In a year about 45,000-50,000 outpatients are seen and about 3,500 surgeries are performed in the department. A total of 1200-1300 refractive surgeries and 650-700 corneal transplants are done each year.

Ophthalmic issues the dept. addresses

The department caters to the efficient diagnosis and management of a wide range of diseases:

Congential and hereditary cornea disorders
Corneal infections
Allergic eye diseases
Immunologic disorders of cornea
Keratoconus and other corneal degenerations
Ocular surface disorders including severe dry eye, blepharitis, chemical injuries, Stevens Johnson's syndrome
Ocular surface tumors
Refractive errors

Surgeries

The department offers most recent advances in the field of corneal surgery which include:

Penetrating Keratoplasty:

(Optical, tectonic and therapeutic) with anterior segment reconstruction, Combined with SFIOL Vitreo-retinal procedures and Paediatric PK

Lamellar corneal surgeries:

Including Deep Anterior Lamellar Keratoplasty (DALK), Deep Lamellar Endothelial Keratoplasty (DLEK) and Descemet's Stripping EndoKeratoplasty (DSEK), Automated Lamellar Therapeutic Keratoplasty (ALTK)

Refractive corneal surgery

Refractive surgery offers the state of art facility for various laser refractive procedures like LASIK, Epi-LASIK, PRK and Wavefront guided customized ablation

Ocular surface reconstruction surgeries
Collagen Cross Linking for keratoconus

Facilities

Ocular Surface Clinic:

The first of its kind in the country, caters to a wide variety of surface disorders including dry eye, chemical injuries, Stevens Johnson syndrome and ocular surface neoplasias. The surgical management includes:
Ocular surface reconstruction
Pterygium surgeries
Stem cell transplantation (limbal autografts and allografts) including Ex-vivo stem cell culture and transplantation
Amniotic membrane transplantation
Mucous membrane grafting
Modified osteo-odonto keratoprosthesis(MOOKP) for severe bilateral end-stage ocular surface disorders

Customized laser refractive surgery:

A strategy to correct not only the refractive error but also the other optical imperfections of the eye, known as aberrations.

Collagen Cross Linking for keratoconus:

COLLAGEN CROSSLINKING : A PARADIGM SHIFT IN KERATOCONUS MANAGEMENT

This revolutionary new treatment offers a new hope in patients of progressive Keratoconus

Keratoconus is a bilateral ocular disorder in which the cornea assumes a conical shape due to thinning of the stromal collagen tissue.It is a relatively frequent disease with an incidence of 1 in 2000 in the general population.It classically has its onset at puberty and is progressive until the third or fourth decade of life when it usually arrests.

Keratoconus can be detected clinically by slit lamp examination by an Ophthalmologist and the diagnosis can be confirmed by corneal topography.

Treatment options

Currently, the mainstay of treatment for Keratoconus include glasses and / or specially designed rigid gas permeable contact lenses which offer good quality of vision in advance cases keratoconus can be corrected surgically by corneal grafting and placement of intracorneal rings. However, all these treatment options only correct the refractory error in Keratoconus and do not address the issue of progression of the disease. Collagen Cross Linking is a new modality of treatment that aims to arrest progression of keratoconus.

What is Collagen crosslinking ?

The corneal collagen is crosslinked with the help of ultraviolet rays ( UVA ) and a photosensitiser, Riboflavin , thus enhancing the rigidity of corneal tissue and stabilizing the condition

Who is a suitable candidate for Collagen crosslinking ?

Patient must be a proven case of keratoconus with documented progression of the disease.
Patient's corneal thickness must be at least 400 microns.
Patient should not be pregnant or nursing.

How is Collagen crosslinking performed ?

The treatment is performed under topical anaesthesia with the patient in a lying down posture in the sterile environment of the operating room. The patient's corneal epithelium is gently removed, following which Riboflavin solution is applied every 5 minutes for the first half an hour. Thereafter the patient's cornea is exposed to UVA light for half an hour. The treatment is painless and lasts for an hour, at the end of which the eye is patched

The cornea is the clear, transparent dome in front of the "black portion" of the eye. It is also the main focusing surface, which converges light rays as they enter the eye to focus on the retina. It is thus the most important part of the optical apparatus of the Eye. Loss of transparency directly results in loss of vision.

When can the patient resume normal routine ?

After the treatment, patient will be able to resume work within 3 to 4 days.Care should be taken to avoid entry of water into the eyes during this period.The use of contact lenses may be resumed 6 weeks after treatment.

How often must the patient come for follow up ?

The surgeon will examine the patient's eye daily for the first 2 to 3 days until the epithelial healing is complete. Eye drops will be used for 4 months. Patient will have to come for follow up at 6 weeks, 3 months, 6 months, 1 year and 2 years after the procedure.

Can both eyes be treated at the same time?

If both eyes are suitable for Collagen crosslinking, the treatment is performed on one eye at a time .The timing of treatment of the second eye is best decided in consultation with your ophthalmologist.

What are the possible side effects of the procedure?

A foreign body sensation, irritation or watering accompanied by pain is not uncommon on the day of treatment. Analgesics for relief from pain will be prescribed , and the pain usually subsides within 24 hours. Dryness of the eyes frequently follows this treatment and may last for 6 to 8 months. Tear lubricants are therefore recommended for the period.

Concerns using UVA light

UVA light can potentially harm the vital cell layer of the cornea known as the endothelium as also the crystalline lens and the retina. However, the use of riboflavin and the choice of the wavelength of UV light used, substantially reduces the intraocular penetration of UV rays to negligible levels. Potential side effects are therefore avoided. It is mandatory to perform a preoperative measurement of the corneal thickness and to exclude patients with corneal thickness less than 400 microns .

The 3 & 5 year results of the Dresden clinical study on collagen crosslinking in human eyes has shown arrest of progression of keratoconus in all treated eyes Collagen crosslinking has thus emerged as a safe and effective , inexpensive non surgical promising new treatment for Keratoconus to slow the progression of the disease and to delay or avoid corneal graft surgery. With more long term experience in the arena , prophylactic treatment of Keratoconus might become possible with collagen crosslinking.

A new modality for arresting progression of keratoconus by strengthening the corneal collagen fibres, involving the use of UV-Light and Riboflavin.

Facilities & Diagnostic Services

Corneal Topography(PENTACAM,TMS-4,TOPOLYZER) - Evaluates shape and power of corneal surface. The Pentacam, based on the Schiempflug photography is unique in that it provides invaluable information that other instruments are incapable of measuring.
Pachymetry - Measurement of corneal thickness
Aberrometry - Measures the optical aberrations of the eyeball
Specular Microscopy - Study of the corneal endothelium (cells that maintain corneal clarity)
Anterior segment digital photography
Immunohistopathlogicial diagnosis of various immune disorders
Specialized Contact lens fitting – for irregular cornea, keratoconus and for therapeutic purposes
Eye Bank
24 hour corneal tissue retrieval, assessment and processing under laminar flow and storage. A dedicated team that promotes awarness of eye donation. Can be contacted through dedicated telephone line number 28281919
 Training and courses offered

Postgraduate teaching:

Aims at providing an in-depth knowledge of various corneal disorders and diagnostic procedures to the postgraduate students.

The Cornea Fellowship training programme:

Comprehensive training programme in various aspects of medical and surgical management of corneal disorders

Research activities

Major ongoing research projects are:

Ex-vivo stem cell culture on human amniotic membrane
Ex-vivo stem cell culture on thermoreversible synthetic polymer
Evaluation of efficacy and safety of episcleral implants for high risk corneal grafts
Multicenter clinical trials involving , various durgs, implants and contact lenses
Genetic diseases in corneal dystrophies

Papers/Publications for last 10 years

Boston Keratoprosthesis in Silicone oil filled eyes: A new indication. Iyer G, Srinivasan B, Gupta J, Rishi P, Sen PR, Bhende P, Gopal L, Padmanabhan P. Cornea. 2011

“Prevalence and risk factors for Pterygium and Pinguecula in south Indian population”. Rashima A, Ramesh S.Ve., V Lokapavani, L Vijaya, George R, has been accepted for publication in Journal Ophthalmic and Physiological Optics

“A study on isolation rate and prevalence of drug resistance among microorganisms isolated from Multi organ donor and Donor corneal rim along with a report on existence of blaNDM-1 among Indian population” accepted by Current Eye Research. Sowmiya M, Malathi J, Vaidehi, Therese KL, Ramarajagopal, Prema Padmanabhan, Madhavan HN.

“Changes in the corneal endothelial cell density and morphology in patients type II diabetic mellitus. A population based study Sankara Nethralaya diabetic retinopathy and molecular genetics study Sankara Nethralaya dreams report-23. Sharma T, R R Sudhir, Rajiv Raman accepted for international cornea journal

Changes in the corneal endothelial cell density and morphology in patient with type 2 diabetes mellitus: a population-based study, Sankara Nethralaya Diabetic Retinopathy and Molecular genetics study. (SN-DREAMS, Report 23). R R Sudhir, Raman R, Sharma T. Cornea 2012.

A study on isolation rate and prevalence of drug resistance among microorganisms isolated from multi organ donor and donor corneal rim along with a report on existence of blaNDM-1 among Indian population. Somiya M, Malathi J, Vaidehi, Therese KL, Rama Rajagopal, Prema P, Madhavan HN. Current Eye Research, 37(3), 195-203, 2012.

Prevalence and risk factors for pterygium and pinguecula in south Indian population. Rashima A, Ramesh S.Ve, V Lokapavani, L Vijaya, George R. Ophthalmic and Physiological optics, 2012,32,39-44.
Outcome of Boston keratoprosthesis in a developing country importance of patient selection, education and perioperative care – The Indian Experience. Asia Pacific Journal of Ophthalmology 2012. Iyer G, Srinivasan B, Nidhi G, Padmanabhan P

The effect of riboflavin-UV-A treatment on corneal limbal epithelial cells. A study on human cadaver eyes. Cornea Journal 2012. Vimalin J, Gupta N, Jambulingam M, Padmanabhan P, Madhavan HN.

Boston Keratoprosthesis and Ahmed glaucoma valve for visual rehabilitation in congenital anterior staphyloma. Indian Journal of Ophthalmol 2012 May;60(3):232-3

Visual rehabilitation with keratoprosthesis after tenonplasty as the primary globe-saving procedure for severe ocular chemical injuries. Graefes Arch Clin Exp Ophthalmol 2012 May.

Clear cornea with large central descemet's membrane tears following birth trauma. Shweta A, Radhika R, Prema P - Delhi Journal of Ophthalmology Feb 2013; 199-201

Lacrimal proline rich 4 (LPRR4) protein in the tear fluid is a potential biomarker of dry eye syndrome. Aluru, Saijyothi V,Shweta A, Srinivasan B,Iyer, G K, Sivakumar M,Tatu, Utpal, Prema P, Nirmala S,Angayarkanni N – PLOS one 2013,4

Corneal changes following collagen cross linking and simultaneous topography guided photoablation with collagen cross linking for keratoconus.Padmanabhan P, Radhakrishnan A, Venkataraman AP, Gupt - Indian J Ophthalmol. 2013

Collagen cross-linking in thin corneas.Padmanabhan P, Dave A - Indian J Ophthalmol. 2013 Aug;61(8):422-4

Comprehensive approach to ocular consequences of Stevens Johnson Syndrome – the aftermath of a systemic condition. Iyer G, Srinivasan B, Agarwal S, Kamala Muralidharan S, Arumugam S - Graefes Arch Clin Exp Ophthalmol. 2014 Jan 29

Comprehensive approach to ocular consequences of Stevens Johnson Syndrome - the aftermath of a systemic condition. Geetha Iyer & Bhaskar Srinivasan & Shweta Agarwal & Seema Kamala Muralidharan & Sumathi Arumugam - Graefes Arch Clin Exp Ophthalmol; Jan:29.2014

Structural & functional rehabilitation in eyes with lamina resorption following MOOKP—can the lamina be salvaged?.Geetha I, Bhaskar S, Shweta A, Shanmugasundaram, Gunaseelan R- Graefes Arch Clin Exp Ophthalmol; 07 March-2014

Corneal changes following collagen cross linking and simultaneous topography guided photoablation with collagen cross linking for keratoconus. Prema P, Aishwaryah R, Abinaya P V, Nidhi G, Bhaskar S - Indian Journal of Ophthalmology; 2014 Vol. 62 No. 2

Comprehensive approach to ocular consequences of Stevens Johnson Syndrome - the aftermath of a systemic condition. Geetha I, Bhaskar S, Shweta A, Seema K M, Sumathi A - Graefes Arch Clin Exp Ophthalmol. 2014 Mar;252(3):457-67

Structural & functional rehabilitation in eyes with lamina resorption following MOOKP—can the lamina be salvaged?. Geetha I, Bhaskar S, Shweta A, Shanmugasundaram S, Gunaseelan R - Graefes Arch Clin Exp Ophthalmol. 2014 May;252(5):781-90

Photoessay on ‘CIN with corneal furrow degeneration. Rishi P, Shields CL- Indian Journal of Ophthalmology

Laminar Resorption in Modified Osteo-odonto-keratoprosthesis Procedure: A Cause for Concern.Iyer G, Srinivasan B, Agarwal S, Rachapalle SR - Am J Ophthalmol. March 2014

Clinico-biochemical Correlation of the Effect of Subconjunctival Bevacizumab for Corneal Neovascularization. Agarwal S1, Angayarkanni N, Iyer G, Srinivasan B, Natarajan R, Charola S, Arumugam S, Padmanabhan P - Cornea. 2014 Jul 31

Apoptosis of Corneal Stromal Cells Induced byTelopeptides: An In vitro Study. Vimalin J, Malathi J, Prema P, Madhavan H N - Ophthalmology Research: An International Journal. 2014:2(6): 40-47

Bone augumentation of the osteo-odnto alveolar lamina in MOOKP – will it delay laminar resorption?. Geetha I K, Srinivsan B, Shweta A, Ekta R, Pukhraj R – Grafes Arch Clinical Exp Ophthalmology 5th May 2015.

Large Lamellar corneoscleral grafts tectonic role in initial management of severe ocular chemical injuries. Geetha I K, Srinivsan B, Shweta A, Ekta R, Pukhraj R - European Journal of Ophthalmology 30th April 2015

Outbreak of Epidemic Keratoconjunctivitis Caused by Human Adenovirus Type 2 in Chennai, India in 2014. Janani MK, Vimalin Jeyalatha M, Prema Padmanaban, Madhavan HN and Malathi - Austin Journal of Clinical Ophthalmology 2015

Corneal collagen cross-linking for Keratoconus in pediatric patients-long term results. Prema P, Sudhir RR, Iyer GK, Srinivasan B, Radhika N, Niveditha v, Meena L Y, Swetha AL, Cornea 2016

Unraveling genomic and phenotypic nature of multidrug-resistant (MDR) Pseudomonas aeruginosa VRFPA04 isolated from Keratitis patient. Murugan N, Malathi J, Umashankar V, Madhavan HN – Microbiological Research 193 (2016)140-149

Tear Fluid Protein Changes in Dry Eye Syndrome Associated with Rheumatoid Arthritis: A Proteomic Approach. Aluru Saijyothi V, Shweta A, Bhaskar S, Geetha K, Sivakumar RM, Utpal T, Padmanabhan P, Angayarkanni N - Ocul Surf. 2016 Oct 24

Corneal collagen cross-linking for keratoconus in pediatric patients- long term results. Prema P, Sudhir RR, Rama R, Radhika N, Geetha I, Sirnivasan B, Meena L, Niveditha N, Shweta A - Cornea Journal. Accepted in October 2016.

Director Dr. Rama Rajagopal

Deputy Director

Dr. N Radhika
Consultants Dr. Aditi Ghosh Dastidar (Kolkatta)
Dr. Bhaskar Srinivasan
Dr. Geetha Krishnan Iyer
Dr. John Sarkar (Kolkatta)
Dr. Mamta Agarwal
Dr. Meena Lakshmipathy
Dr. Mona Bhargava (Kolkatta)
Dr. Niveditha Narayanan
Dr. Prema Padmanabhan
Dr. Ravi Daulat Barbhaya (Kolkatta)
Dr. R R Sudhir
Dr. Shweta S Agarwal
 
Director - Cornea
Dr. Rama Rajagopal
Sankara Nethralaya, JKCN Complex,
21, Pycrofts Garden Road,
Chennai 600 006.
E-Mail ID:drrrg@snmail.org
Tel: 91-44-28233556, 28271616, 28311913
Extn: 2251
Deputy Director - Cornea
Dr. N Radhika
Sankara Nethralaya, JKCN Complex,
21, Pycrofts Garden Road,
Chennai 600 006.
E-Mail ID: drnr@snmail.org
Tel: 91-44-28233556, 28271616, 28311913