Corneal Surgery

The clear covering of the eyeball is called the cornea. Surgery is performed on the cornea for two main reasons. One is to remove scarring and clouding that interfere with vision. The other is to change the curve of the cornea to correct vision problems. These problems include nearsightedness and farsightedness. Operations on the cornea can be performed with traditional surgical tools or laser surgery can be used.

Who is a candidate for the procedure?

The best candidates for this type of surgery are people with corneal conditions whose vision can’t be corrected by wearing glasses or contact lenses. Many people also choose to have corneal surgery for convenience and for cosmetic reasons.

How is the procedure performed?

Several procedures can be performed on the cornea to restore its clarity and allow more light to pass through. Common procedures include the following:

A procedure called a conjunctival flap is done when the cornea is diseased and painful. It can also be done when there is danger of the cornea tearing because it is too thin. The mucous membrane that covers the white portion of the eye, called the conjunctiva, is brought over the cornea and stitched in front of it. This provides comfort and protection for the eye. However, the eye will no longer be able to see.

In the last decade, procedures have been developed to correct nearsightedness, farsightedness, and astigmatism. These are termed refractory surgery. One of the first of the procedures was radial keratotomy, or RK. This operation consists of spoke-like cuts in the edges of the cornea. The cuts do not extend over the area covering the pupil. The cuts allow the edges of the cornea to weaken and bow. This causes the area of the cornea over the pupil to flatten and decreases the person’s nearsightedness. While this operation is still performed today, it has been almost completely replaced in the United States by a procedure called LASIK.

LASIK, or laser in situ keratomileusis, is usually done on both eyes at once. It can be used to correct farsightedness and nearsightedness with or without astigmatism. In this technique, a thin flap of the cornea is lifted. Then a laser is used to dissolve very thin layers of corneal tissue under the flap and create a flatter surface over the pupil. After the laser treatment, the flap is repositioned.

A procedure to correct farsightedness with astigmatism should receive FDA approval soon. Other methods for reshaping the cornea are also under investigation. One of these involves the use of a peripheral corneal ring. Also, a technique for implanting an artificial lens in the eye to correct vision problems shows promise as an alternative to LASIK.

What happens right after the procedure?

Corneal surgery is usually done on an outpatient basis in a same day surgery center. An eye patch may be put on after surgery. The person will be taken to the surgery recovery room. Once all the effects of anesthesia have worn off, and the person is able to drink fluids without nausea, he or she will be able to go home.

What happens later at home?

The main problem to be avoided after surgery is infection. For this reason, individuals will be told to use antibiotic eyedrops. Steroid drops are often prescribed as well to promote healing. In addition, people who have corneal surgery may need to use a type of eyedrops called artificial tears to make the eyes more comfortable. These do not contain any medication. Many people have their vision completely corrected with this surgery. Others may still need to wear corrective lenses. Recovery can take several months.

What are the potential complications after the procedure?

Surgery can cause bleeding, infection, and allergic reaction to anesthesia. The major risks of corneal surgery are overcorrection and undercorrection of the vision problem. Undercorrection can be treated with further surgery. Any new or worsening symptoms should be reported to the healthcare provider.