+977-91-575112 , 575204

info@getaeyehospital.org.np

Cornea Services

Geta eye hospital has been providing eye care services for more than 4 decades. In the yester years, we were primarily focused in reducing the large volume of cataract patients which was the principal cause of the preventable blindness in Nepal. With the changes in time and priorities and the subsequent introduction of sub-specialty services in many tertiary eye hospitals of Nepal, there was a dire realization to institute and develop sub-specialty units to provide necessary eye treatment for the increasing volume of patients. Based on that vision, cornea specialty services at Geta eye hospital commenced in 2012 along with the corneal transplantation surgery the same year.

Corneal disease is one of the most common reasons for hospital visit in any eye care facility. A survey done in 2021 ‘RAAB’ (Rapid Assessment of Avoidable Blindness) has clearly depicted that corneal pathologies accounted as the second most common cause for preventable blindness after cataract. Therefore the magnitude of this problem further necessitates the strengthening of the available services in terms of accessibility and affordability.

Being the most anterior part of the eye, cornea is always exposed to the various external environments that make it more vulnerable to trauma/injury whether inflicted or accidental. Hence, the patients visiting our cornea clinic usually has a history of trauma in one or the other form, commonly presenting as corneal ulcer or keratitis.

Most commonly encountered corneal pathologies in our cornea clinic are:

  • Corneal ulcer/keratitis (bacterial/fungal/viral/protozoal)
  • Immune-mediated keratitis
  • Dry eye disorder/syndrome
  • Ocular surface neoplasia
  • Chemical and thermal ocular burn
  • Corneal laceration and perforation
  • Ectasia, dystrophy and degeneration
  • Pseudophakic and aphakic bullous keratopathy

Our cornea unit is determined and dedicated in providing the rational treatment for different corneal morbidities. Proper diagnosis and early treatment is pivotal in the management of most corneal diseases e.g. corneal ulcer, to prevent further complications and sequelae that might lead to visual impairment in the future. With the available diagnostic tools and the clinical expertise, we provide the most appropriate treatment to the patients. Treatment spectrum involves use of topical and/or systemic antibiotics, antifungals, anti-viral agents as well as steroids. Corneal transplantation on the other hand is indicated in patients:

  • who fail to respond to medical management and develop complication e.g. ulcer perforation
  • who require vision restoration secondary to corneal opacity.

For diagnostic tests we have:

  • Complete baseline blood workup
  • Serology markers
  • Corneal scrape for Gram & KOH stain, culture sensitivity
  • Anterior segment OCT (optical coherence tomography)

Currently available therapeutic armamentarium consists of:

  • Corneal ulcer/keratitis treatment
  • Dry eye disorder/syndrome treatment
  • Corneal laceration and perforation repair
  • Ocular surface neoplasia: Wide margin tumor excision +/- Mitomycin C with conjunctival autograft
  • Symblepharon : Symblepharon release and conjunctival autograft
  • Recurrent pterygium: PERFECT surgery
  • Small corneal perforation: Gunderson’s flap, corneal patch graft, Bandage contact lens application with tissue adhesive
  • Salzmann’s nodular degeneration: Superficial keratectomy
  • Band shaped keratopathy: EDTA chelation
  • Non-healing/ recalcitrant corneal ulcer and perforated ulcer: Therapeutic penetrating keratoplasty (TPK)
  • Stable corneal scar/opacity: Optical penetrating keratoplasty (PK)
  • Corneal scar with cataract: Triple Procedure ( Penetrating keratoplasty with cataract extraction and intraocular lens implantation)

With newer advances in technology and clinical practice, the cornea unit is planning to further expand the available treatment modalities. Newer services in the pipeline are:

  • Deep anterior lamellar keratoplasty (DALK)
  • Descemet’s membrane endothelial keratoplasty (DMEK)
  • Descemet’s stripping endothelial keratoplasty (DSEK)
  • Amniotic membrane graft (AMG)
  • Simple limbal epithelial stem cell transplant (SLET)
  • Corneal topography
  • Collagen cross-linking (CXL)

 

In the last fiscal year 2079-2080 (2022-2023), a total of 9975 patients sought cornea consultation and 242 corneal transplant surgeries were performed. Below is the graphical representation of the patient demographics in cornea clinic and the different type of corneal surgeries performed in the same time period.

Dr Anil Gurung

 

Dr Anil Gurung, Unit Head: Consultant Cornea/Ocular surface & Cataract/Phaco-surgeon.

MBBS (KU)- 2002, MD (NAMS)- 2013, Cornea Fellowship- Biratnagar Eye Hospital, 2018.

Dr Gurung joined Geta eye hospital in December 2013. For more than a decade he has been providing services to the people of Far-western province and the neighboring Indian states. After the completion of cornea fellowship in 2018, he has been assigned in the post of cornea consultant.