Our corneal surgeons at UC Irvine’s Gavin Herbert
Eye Institute are certified by the American Board of
Ophthalmology. Additionally, all have had advanced fellowship
training in corneal, cataract, and refractive surgery. UC Irvine
corneal surgeons are leaders in their field. They are the first
in Orange County to implant a miniature telescope (IMT) in
the eyes of patients with end-stage age-related macular degeneration.
Click HERE to
Our relationship with you as a patient is focused on fulfilling
the needs and priorities of your eye condition, applying state-of-the-art
diagnosis and surgical procedures, and supplying experienced advice
for achieving your best possible visual results.
Corneal transplantation involves replacing a diseased or scarred cornea with
a clear one, usually donated through an eye bank. The cloudy cornea is removed
with a cookie-cutter-like instrument called a trephine and the new one is
secured in its place with a suture, which remains for months or even years
until the eye heals properly. Eye drops to promote healing and prevent rejection
will be needed for several months after the outpatient procedure.
The Gavin Herbert Eye Institute ophthalmologists have developed
and pioneered the use of femtosecond lasers to make the incisions
in cornea transplants. These incisions have been proven to reduce
astigmatism and speed vision recovery.
Specialized corneal transplantation techniques, including descemet-stripping
endothelial keratoplasty (DSEK and DSAEK) and deep anterior lamellar
keratoplasty (DALK) are all performed on a regular basis by eye
surgeons with UC Irvine’s Gavin Herbert Eye Institute.
A transplant operation requires a healthy cornea from a donor
who is recently deceased. The source of the donor tissue is usually
a local or national eye bank.
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Conventional keratoplasty refers to a standard corneal transplant using a circular
blade, known as a trephine, to create an incision.
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Femtosecond Laser Keratoplasty
laser keratoplasty is a corneal transplantation or grafting technique
using a femtosecond laser, which was has been developed by the
Gavin Herbert Eye Institute ophthalmologists. This method uses
a laser capable of pulsing more than 60,000 times per second to
create a modified zigzag incision. This new technique results in
a faster recovery and less astigmatism compared to conventional
corneal transplantation methods. We are the leading center for
Femtosecond Laser Keratoplasty. Depending on the reason for your
surgery, this may be the best option for your corneal transplant.
Optical Coherence Tomography (OCT) showing lock-and-key
configuration in a femtosecond laser keratoplasty.
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Deep Anterior Lamellar Keratoplasty (DALK)
Deep Anterior Lamellar Keratoplasty is a special type of corneal transplant
in which only the anterior (front) part of the cornea is transplanted. The
back layer of your cornea is retained. DALK allows for less chances of corneal
rejection. At the Gavin Herbert Eye Institute, we have pioneered the combined
use of the femtosecond laser and the DALK technique to allow a customized
partial layer corneal transplant with the added benefits of the laser. This
may be an option for you depending on the reason for your corneal transplant.
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Descemet Stripping Endothelial Keratoplasty (DSEK / DSAEK)
or descemet stripping endothelial keratoplasty, is a specialized
corneal transplantation technique. Corneal transplants are
done to repair damaged or diseased corneas. During the DSEK
procedure, the damaged or diseased inner layers of the cornea
known as the endothelium are removed and replaced with a
healthy donor cornea.
Patients who have a corneal transplant done using the DSEK method
recover faster and are able to resume their normal activities sooner.
Additionally, suture related complications are essentially eliminated
and there is minimal change in the refractive error since the front
part of the patient’s cornea is left intact.
Descemet Membrane Endothelial Keratoplasty (DMEK)
DMEK is the latest evolution in the treatment of endothelial corneal disease. In this surgery, a paper-thin graft is transplanted that is essentially a swap for your diseased endothelium.
DMEK is very similar to DSAEK, except that the donor tissue implanted does not include any stroma tissue. It is a pure replacement of endothelium. This tends to give better visual results and a quicker recovery; however, donor disc dislocations are more common. You should discuss both options with your surgeon.
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is a non-inflammatory corneal condition in which the normal dome
shaped architecture of the cornea is distorted. The cornea progressively
thins and the normal corneal contour becomes conical. Keratoconus
is usually diagnosed in young people (puberty or late teens).
It usually affects both eyes, generally with different severity.
Keratoconus usually progresses for 10-20 years and then stabilizes.
In the early stages, keratoconus causes blurring of vision, which
can be treated with glasses or soft contacts. As the disorder
progresses, hard contact lenses are generally needed to correct
vision adequately. Depending on the severity of the condition,
there are several therapeutic options including: intrastromal
rings (INTACS), conventional penetrating keratoplasty (corneal
transplant), femtosecond laser assisted keratoplasty (laser corneal
transplant), and deep anterior lamellar keratoplasty using the
femtosecond laser (nearly full thickness laser corneal transplant).
Additionally, we are excited to offer an FDA approved protocol of collagen crosslinking (CXL). CXL aims to halt or slow down the progression of keratoconus in the early or moderate stages to allow visual rehabilitation with glasses or contacts and delaying or all together avoiding corneal transplantation. Corneal crosslinking combines the application of riboflavin with ultraviolet-A light. Together, these increase corneal strength and stability by inducing new crosslinks between or within collagen fibers. In clinical trials, crosslinking has been shown to halt the progression of keratoconus and ectasia and to enhance the biomechanical stability of the cornea. Crosslinking is now approved for use in the US.
The corneal surgeons at the Gavin Herbert
Eye Institute are world leaders in the management of Keratoconus
and laser corneal transplantation.
Map of cornea showing keratoconus
(Area with thinning highlighted in red)
corneal inserts are surgically implanted in the cornea primarily
to treat keratoconus. In the past, these inserts also have been
used to treat mild cases of myopia. The insert works by flattening
the part of the cornea that is too steep, there by reducing visual
distortions. INTACs are useful in restoring a more normal corneal
contour. This may allow increased contact lens tolerance and
may avoid need for a corneal transplant.
Fuchs’ Endothelial Dystrophy
dystrophy causes the inner layer of cells of the cornea (endothelium)
to deteriorate over time. As these cells breakdown, the endothelium
of the eye becomes unable to process and pump water from the
body of the cornea, which causes the cornea to swell and become
As the cornea’s normal architecture changes, the patient’s
vision becomes hazy and tiny blisters form on the cornea. The blisters
can be very painful when they burst.
Initial symptoms of Fuchs’ endothelial dystrophy include morning blurry
vision which clears as the day progresses. This is due to the cornea retaining
fluid as the patient sleeps. As the disease progresses, the swelling does not
subside and the blurred vision continues throughout the day.
Initially, this disease can be treated with drops, but as the
condition worsens, a corneal transplant may be required for visual
rehabilitation. Patients with Fuchs’ dystrophy often do very
well with a specialized type of corneal transplant: Descemet Stripping
Endothelial Keratoplasty (See below).
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Pseudophakick Bullous Keratopathy:
is a condition in which one's cornea has become permanently swollen
(corneal edema) following cataracts and intraocular lens implant
procedure. The cells that line the back inside surface of the
cornea (the endothelium), for one of various reasons, have been
injured permanently. The function of the endothelium is to pump
water out of the cornea, keeping it crystal clear and thin. When
injured, these cells can no longer perform this function. The
fluid that circulates inside the eyeball seeps into the cornea,
causing it to swell and to become cloudy. This condition is called
pseudophakic bullous keratopathy.
The causes of endothelial cell damage following cataract operations
are multiple. They include physical trauma during the operation,
such as difficulties in removing the cataract or inserting the
intraocular lens, severe inflammation following the operation,
intraoperative bleeding, or a predisposing disease called Fuchs'
endothelial dystrophy that makes the cornea prone to losing endothelial
cells. When one is afflicted with pseudophakic bullous keratopathy,
the cornea is permanently swollen and no medications, spectacles,
or contact lenses can improve the vision of a patient with this
condition. Patients with Pseudophakic Bullous Keratopathy often
do very well with a specialized type of corneal transplant: Descemet
Stripping Endothelial Keratoplasty (See below).
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Intraocular Lens Complications
lenses (IOL) are placed at the time of cataract surgery to
allow for focusing of light. Generally, IOLs are very well
tolerated and cause no problems. If the IOL is not placed correctly,
intraocular lens decentration may occur. This also may happen
if there is trauma to the eye. Symptoms of decentration include
glares, halos and reduced vision. If this occurs the intraocular
lens must be repositioned surgically. Intraocular p ower miscalculation
also can occur if the implanted lens is not the right power
to correct the patient’s vision. This can also require
surgical replacement or laser vision correction.
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Limbal Stem Cell Transplantation
Severe ocular surface diseases are a group of disorders leading to corneal
limbal stem cell deficiency. These include chemical or thermal burns of the
eye, congenital diseases such as aniridia, immunological disorders such as
Steven’s Johnson Syndrome (SJS) and ocular cicatricial pemphigoid,
infectious diseases resulting in long term ocular surface scarring such as
trachoma or herpetic eye disease, and other causes such as chronic contact
lens wear. These all culminate in a deficiency of ocular surface stem cells
which results in progressive neovascularization and clouding of the cornea.
This leads to severe visual impairment and, ultimately, to blindness. Current
advances in limbal stem cell transplant technology now allow the transplant
of cadaver or living related stem cells onto the ocular surface and the regeneration
of an optically clear cornea with resulting gain of vision. Depending on
the etiology of the disease, living-related donor tissue, cadaver tissue,
or a combination of both are transplanted onto the ocular surface to build
the necessary micro environment required for ocular surface health and healing.
The Gavin Herbert Eye Institute is one of only a handful of centers in the
United States to offer this technology.
|Before Limbal Stem
||After Limbal Stem
Boston keratoprosthesis is an "artificial cornea" that
is indicated in patients who are poor candidates for a traditional
corneal transplant. Patients who have had multiple previously
failed standard corneal transplants or those with severe ocular
surface disease who are poor candidates for limbal stem cell
transplants may be candidates for the Boston keratoprosthesis.
This technology was developed over 40 years ago and has undergone
multiple advances. It gained FDA clearance in 1992. The current
model consists of
a clear plastic optic which is assembled onto a cadaver corneal
tissue. This complex is then transplanted onto the eye in a similar
fashion to the traditional corneal transplant. Long-term care
and maintenance are the keys to its success. The chronic use
of a bandage contact lens and antibiotic drops have allowed the
improved safety and long term viability of the artificial cornea.
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pterygium is a pinkish, triangular-shaped growth over the cornea,
that develops slowly over a person’s life and are more
commonly found in sunny climates among people ages 20 to 40.
Only rarely do pterygia grow large enough to cover the pupil.
Surgery is not advised unless it affects vision. Removal of a
pterygium is an outpatient procedure that takes less than an
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Implantable telescope for macular degeneration
cornea specialists, in conjunction with our retina specialists,
at the Gavin Herbert Eye Institute are excited to be a “center
of excellence” for the CentraSight implantable telescope.
This new technology allows for improved vision and quality of
life. Click HERE for
more information on CentraSight.
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infections can be caused by bacteria, fungi, from wearing a contact
lens, damage to the cornea by a foreign object, or a variety
of other causes. Symptoms include pain and inflammation to the
eye, reduced vision and corneal discharge. Over time the infection
can lead to corneal erosion and scarring. Minor infections can
be treated with drops. In more serious cases, corneal transplantation
may be required to restore vision.
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Dry eye is a very common condition in
which the eye does not produce enough tears, or when tears do not
function properly and evaporate too quickly.
Additionally, inflammation of the surface
of the eye may occur along with dry eye. Untreated, dry eye can
cause pain, ulcers, or scars on the cornea, and blurry vision.
Dry eye can make it more difficult to perform some activities,
such as watching TV, using the computer, and reading.
Other names for dry eye include dry
eye syndrome (DES), keratoconjunctivitis sicca (KCS), dysfunctional
tear syndrome, lacrimal keratoconjunctivitis, evaporative tear
deficiency, aqueous tear deficiency, and LASIK-induced neurotrophic
Dry eye symptoms
may include any of the following:
- Stinging or burning of the eye
- A foreign body sensation in the eye
- Episodes of excess tears following very dry eye periods
- A stringy discharge from the eye
- Pain and redness of the eye
- Episodes of blurred vision
- Heavy eyelids
- Intolerance to contact lenses
- Decreased tolerance of reading, working on the computer, or
any activity that requires sustained visual attention;
- Eye fatigue
Depending on the causes of dry eye,
the doctors at the Gavin Herbert Eye Institute may use various
approaches to relieve the symptoms.
Dry eye can be a chronic condition.
The first priority is to determine there is an underlying cause
of the dry eye (such as Sjögren's syndrome or lacrimal and
meibomian gland dysfunction). If it is, then the underlying disease
needs to be treated.
The mainstay of treatment is lubrication.
Your doctor may have you use artificial tears, preservative-free
artificial tears, and/or ointments initially. Additionally, cyclosporine,
an anti-inflammatory medication, can be prescribed. Cyclosporine
is the only prescription drug available to treat dry eye. It decreases
corneal damage, increases basic tear production, and reduces symptoms
of dry eye. It may take three to six months of twice-a-day dosages
for the medication to work. In some cases of severe dry eye, short
term use of corticosteroid eye drops that decrease inflammation
If dry eye results from taking a systemic
medication, your doctor may recommend switching to a medication
that does not cause the dry eye side effect.
If contact lens wear is the problem,
your doctor may recommend another type of lens or reducing the
number of hours you wear your lenses. In the case of severe dry
eye, your doctor may advise you not to wear contact lenses at all.
Another option is to plug the drainage
holes, small circular openings at the inner corners of the eyelids
where tears drain from the eye into the nose. Lacrimal plugs, also
called punctal plugs, can be inserted painlessly by your doctor.
These plugs are made of silicone, are reversible, painless, and
are a temporary measure.
In some patients with dry eye, supplements
or dietary sources (such as tuna fish) of omega-3 fatty acids (especially
DHA and EPA) may decrease symptoms of irritation. The use and dosage
of nutritional supplements and vitamins should be discussed with
your primary medical doctor.
Finally, in severe cases, the use of
autologous serum drops may be advised. In this situation, your
own blood is drawn and spun down to eliminate the blood cells.
The serum is then processed and bottled for use as drops on the
ocular surface. At the Gavin Herbert Eye Institute, we have the
facility and expertise to determine if this is a treatment option
Herpes Eye Infection
herpes, or herpes eye infections are caused by the type 1 herpes
simplex virus. Herpes eye infections can be transmitted through
by close contact with a person who is experiencing an active
There are several forms of ocular herpes. Herpes keratitis is
a viral corneal infection that typically infects the epithelium,
or top layer, of the cornea. In cases of stromal keratitis, the
infection involves deeper levels of the cornea, and may lead to
scarring and loss of vision. According to the National Eye Institute,
stromal keratitis condition is one of the leading causes of corneal
scarring in the United States. Another serious form of ocular herpes
is iridocyclitis, which involves inflammation of the iris and surrounding
tissues, causing severe light sensitivity, blurry vision, and red,
Symptoms of ocular herpes include inflammation of the cornea,
cloudy or blurry vision, recurrent eye infections and irritation,
eye sores, tearing and discharge.
Treatment for ocular herpes depends is on where the infection
occurs. For more superficial cases, antiviral eye drops or medications
may be used. Surgical treatments such as like debridement or corneal
transplants may be recommended for more serious cases.
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appointments, please call:
UC Irvine Medical Center
Gavin Herbert Eye Institute Building
Laser Refractive Surgery