For us to see and enjoy the beautiful colours of life, the front part of the eye (the cornea) has to be smooth, clear and transparent. The corneal surface is maintained in a healthy condition by regular turnover of its first layer derived from a pool of self-renewing cells. Any injury to the eye with either a chemical (burst chuna packet, laboratory chemical), heat (burst pressure cooker, steam injury to the eye, molten metal injury at factories) or fire cracker can lead to the loss of this transparency of the cornea and hence a persistent red eye and a reduction in the vision. No corneal transplant surgery works for vision in such kind of ocular injuries. Until recently, there was no treatment for such patients. However, stem cell research in eye and its practical application in ocular surfacemanagement, has given magical results that are beyond imagination. Earlier this stem cell work required extensive laboratories, hence limiting this wonderful treatment options to few institutes. But as the technique of Simple Limbal Stem Cell transplantation (SLET) has popularised, in expert hands the results are visually and anatomically excellent.
Dr Rajat specialises in transplantation of specialised cells from the patient’s other eye to the affected eye. He is one of the very few trained to perform such surgery in the country. This helps in restoring the vision for most of such patients. For patients who have very severe injuries, we have the option of artificial cornea, the Keratoprosthesis.
:Note to our patients: Limbal stem cell transplantation is a highly specialised surgery. It gives good results in trained hands, if the type and the time of surgical procedure is chosen correctly.
Stevens Johnson Syndrome is a general disease of the body in which the patient develops blisters all over the body. While amniotic membrane transplantation as early as possible is an ultimate necessity, patients with long duration of the illness develop complications. Their roughened eyelid constantly rubs against the cornea with every blink leading to a loss of corneal transparency and a subsequent decrease in vision. This is a group of patients whom no eye surgeon wants to attend to due to their long illness and multiple complications. Dr Rajat has keen interest in the visual restoration of this group of patients. It’s the happiness on their faces once they are treated, which is a motivation for him to work for them endlessly. While early patients of lid margin disease can benefit from a special type of scleral contact lenses, severe forms of the disease require surgery. We offer mucous membrane transplantation surgery where a small piece of the inner lip or the inner cheek is taken and attached to the lid margin. This 3-4 hour surgery is a demanding, multi-speciality surgery and Dr Rajat has trained himself to perform such procedure. The lip or the cheek area heals within 3-4 weeks, usually leaving behind no deformity. Once successful, this prevents the eyelid to come in contact with the cornea repeatedly.
The aim of the surgery is to give symptomatic relief to the patients who are havinge this long ailing state.
Note for the patients: End stage blindness in SJS is now preventable by a timely use of scleral contact lenses or by performing an MMG surgery.
The human amniotic membrane is the innermost layer of the placenta. In the past few years, Amniotic Membrane transplantation has achieved a very important role to an eye surgeon. Effective, prompt and appropriate application of this transparent membrane in patients of chemical injuries (with ‘chuna’/ lime, holicolors, factory chemicals etc.) or acute Stevens Johnson Syndrome (a condition characterised by sudden appearance of blisters all over the body, especially around the mouth and face, most commonly after a drug reaction) is very important for long-term visual rehabilitation of the patient. After the amniotic membrane is procured from the placenta, it is cleaned, washed, tested for transmittable diseases, processed and preserved in a specialized pink coloured media, before using it or ocular procedures We perform Amniotic Membrane transplantation for our patients for such emergency situations. The membrane is requested from an International standard Eye Bank at L V Prasad Eye Institute (Hyderabad) who regularly sends it to eye surgeons across the country. For the benefit of our patients, we specialize in application of this membrane without the use of sutures using biological glue.
Note for the patients: Doing Amniotic membrane grafting/ transplantation (AMG) as early as possible, in patients of chemical injury or Stevens Johnsons Syndrome is very essential. The long term outcome is significantly better in these patients as compared to others.
Physical or chemical injuries of the eye can be a serious threat to vision if not treated appropriately and in a timely fashion. The most obvious presentation of ocular (eye) injuries is redness and pain of the affected eyes. This is not, however, universally true. Injuries to the eye usually cause less pain or no pain at all because of the lack of nerve endings inside the eye. An emergency that must be treated within minutes includes chemical (acid, alkali, chuna, holi colour) or thermal (heat, steam, fire-cracker, molten metal) burns to the eye. An urgent case must be treated within hours. This includes corneoscleral trauma (penetrating injuries – corneal/ scleral tear, abrasion or corneal foreign bodies), blunt trauma causing hyphema (no tear but blood in anterior chamber), eyelid tears, radiant energy burns such as welder's burn. Earliest possible management of trauma cases gives best results. It may require multiple subspecialty surgeons opinion for complete visual rehabilitation. At drishtiCONEeyecare, we understand the importance of early treatment and hence the ocular trauma services are offered 24x7 and 365 days of the year. We specialize in the treatment of all types of ocular trauma cases – chemical, thermal or mechanical.
Emergency management is case dependent. The primary goal in a penetrating injury (corneal/scleral tear) is earliest possible micro-surgical repair of the wound, hence minimising the tissue loss with the aim of prevention of infection. In chemical injuries, the primary aim is to get rid of the offending chemical which is done by a copious irrigation of the eye. Subsequent decision making regarding the use of amniotic membrane in acute stage chemical injury is very important and goes a long way for visual rehabilitation of the patient. (See Cornea Services – Amniotic Membrane transplantation) Appropriate assessment of the severity of damage to the ocular structures at the time of acute presentation, is sometimes difficult due to extensive collateral damage and is done in due course.
After the acute stage management of the injury, assessment is made regarding the severity of the initial trauma and its after effects. The time period before intervention for visual rehabilitation depends on the patient’s age and the mode and severity of the initial injury. For penetrating injuries, the management involves clearing of the visual axis so that adequate light falls on the retina as before to give a clear vision. Although specialised management options are patient-specific, this is done usually by performing a cataract surgery to remove the opacified lens after trauma and by the use of contact lens to account for the irregularities in the cornea. Complex cases involving multiple eye structures, require complex single or multi-step surgeries including vitreoretinal and glaucoma surgeries. We at drishtiCONE eye care specialize in all kinds of cataract, VItreoretinal, glaucoma and oculoplasty surgeries. We are one of the very few centres in the country who offer adequate, long term visual rehabilitation for patients of chemical or thermal burns. Treatment options include the use of amniotic membrane and limbal stem cell transplantation. For very severe injuries we have the option of keratoprothesis (artificial cornea). (See Cornea Services – LSCT)
Dr Rajat Jain’s scientific papers on Ocular Surface Diseases