Cornea Surgery

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 learn more.

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.

Conditions - Click for more details
Physicians

 

Corneal Transplantation
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.

View Video 

Download a Brochure

top of page


Conventional Keratoplasty
Conventional keratoplasty refers to a standard corneal transplant using a circular blade, known as a trephine, to create an incision.

top of page


Femtosecond Laser Keratoplasty
Femtosecond 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 wound
configuration in a femtosecond laser keratoplasty.

top of page


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.

top of page


Descemet Stripping Endothelial Keratoplasty (DSEK / DSAEK)
DSEK, 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.

View Video 

top of page


Keratoconus:
Keratoconus 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)

 View Video

top of page


INTACs:
INTACs 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.

top of page


Fuchs’ Endothelial Dystrophy
Fuchs’ endothelial 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 distorted.

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).

View Video 

top of page


Pseudophakick Bullous Keratopathy:
This 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).

top of page


Intraocular Lens Complications
Intraocular 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.

top of page


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
Cell Transplantation
  After Limbal Stem
Cell Transplantation
 

top of page


Boston Keratoprosthesis
The 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.

top of page


Pterygium
A 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 hour.

 

View Video 

top of page


Implantable telescope for macular degeneration
The 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.

 

 

 

top of page


Corneal Infections
Corneal 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.

View Video 

top of page


Dry Eyes:

dry eye lipiflow

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 epitheliopathy (LNE).

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

View Video 

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 is required.

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 for you.

top of page


Herpes Eye Infection
Ocular 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 herpes episode.

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, painful eyes.

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.

View Video 

top of page

For ophthalmology appointments, please call:

UC Irvine Medical Center
714-456-7183

Gavin Herbert Eye Institute Building
949-824-2020

Laser Refractive Surgery
949-824-9970

 

CATARACT SURGERY
Anand Bhatt, M.D.
Marjan Farid, M.D.
Sumit (Sam) Garg, M.D.
Sanjay Kedhar, M.D.
Sameh Mosaed, M.D.
Matthew Wade, M.D.

COMPREHENSIVE
Kavita K. Rao, M.D.

CORNEA SURGERY
Marjan Farid, M.D.
Sumit (Sam) Garg, M.D.
Sanjay Kedhar
Matthew Wade, M.D.

GLAUCOMA
Anand Bhatt, M.D.
Sameh Mosaed, M.D.

LASIK REFRACTIVE SURGERY
Marjan Farid, M.D.
Sumit (Sam) Garg, M.D.
Robert Lingua, M.D.
Matthew Wade, M.D.

NEURO-OPHTHALMOLOGY
Chantal Boisvert, M.D.
R. Wade Crow, M.D.

OPHTHALMIC PATHOLOGY
Donald S. Minckler M.D.

OPHTHALMIC PLASTIC & RECONSTRUCTIVE SURGERY/
OCULOFACIAL COSMETIC SURGERY

Jeremiah Tao, M.D.

OPTOMETRIC SERVICES
Kathleen Dang, O.D.
Scott Liegler, O.D.
Kailey Marshall, O.D.

PEDIATRIC OPHTHALMOLOGY
Chantal Boisvert, M.D.
Robert Lingua, M.D.
Jennifer Simpson, M.D.

RESEARCH
Lbachir BenMohamed, Ph.D.
James Jester, Ph.D.
Tibor Juhasz, Ph.D.

M. Cristina Kenney, M.D., Ph.D.
Henry Klassen, M.D., Ph.D.
Anthony Nesburn, M.D.
Eric Pearlman, Ph.D.
Jing Yang M.D.

RETINA/VITREOUS
Andrew Browne, M.D., Ph.D.
Baruch Kuppermann, M.D., Ph.D.

Stephanie Lu, M.D.
Mitul Mehta M.D.

UVEITIS
Sanjay Kedhar, M.D.

For ophthalmology
appointments, please call:

Gavin Herbert Eye Institute
949-824-2020

Laser Refractive Surgery
949-824-9970

UC Irvine Medical Center
714-456-7183

Optical Shop
949-824-7690 Phone
949-824-8850 Fax


FIND A DOCTOR

 


 

 

contact doctors doctors directions map