Year : 1994 | Volume
: 42 | Issue : 4 | Page : 169-
Cornea and blindness
Gullapalli N Rao
|How to cite this article:|
Rao GN. Cornea and blindness.Indian J Ophthalmol 1994;42:169-169
|How to cite this URL:|
Rao GN. Cornea and blindness. Indian J Ophthalmol [serial online] 1994 [cited 2020 Sep 19 ];42:169-169
Available from: http://www.ijo.in/text.asp?1994/42/4/169/25567
The structural and functional integrity of the cornea is of paramount importance for normal visual function. Its external location makes it vulnerable to a variety of insults, each of which can lead to sight-threatening sequelae. Another dimension is the refractive properties of the cornea that have made it very susceptible to surgical onslaughts for correction of refractive errors.
Infections, injuries, malnutrition, congenital or hereditary problems and iatrogenic diseases constitute the gamut of aetiologic factors leading to corneal blindness. The magnitude of this problem is overwhelming as per the available statistics. My personal experience and discussions with other colleagues from all over India suggest that infections may constitute the leading cause of corneal blindness in India today.
Infectious keratitis, although has the potential for devastation, is a preventable entity. Appropriate public education about hygiene, prompt treatment for corneal trauma and infections can be an effective prophylaxis against corneal blindness. Once the infection sets in, bacterial disease can be controlled with medical therapy. Highly potent antibacterial drugs are available and successful formulae have been described extensively in ophthalmic literature. In other forms or infectious corneal diseases, however, medical therapy is not that effective, often necessitating surgical intervention. Experience of all investigators around the world. corroborate this observation. Antifungal, antiviral and antiamoebic drugs of greater potency are required to minimize the need for surgery.
The review article in this issue surveys the current thinking about this common problem encountered by most ophthalmologists in their practices. In addition to the well defined clinical entities, we should also be aware of the potential for newer forms of corneal infection. While microbiological assistance may not be available to all of us, in cases that do not respond to therapy, one should make every effort to get this information. This may help to modify the therapeutic strategy and help in arresting the disease. A clear cut approach to the management of corneal infections, followed by every ophthalmologist, can have a salutary effect on the magnitude of corneal blindness.
All these discussions bring two issues to the fore, namely, prevention programmes against corneal blindness and all aspects of corneal transplantation. The best examples of successful prevention programmes in the area of corneal disease are the marked reduction in the incidence of keratomalacia and trachoma. These represent what good planning and implementation can accomplish. Public education and better training of ophthalmologists can certainly minimize blindness from infections, injuries, drugs, surgery and congenital problems. A symbiotic effort between the profession and government is critical for the formation of strategies in this direction.
In the area of corneal transplantation, eye banking and training of corneal surgeons are two challenges ahead of us. Both have been initiated and parallel progress of these two vital segments at an accelerated pace is needed to create an impact. Here again, collaboration between the profession, government and the public holds the key for the successful outcome of such efforts in our country.
As a corneal surgeon, one factor that I have become acutely conscious of is the accessibility to appropriate postoperative care for patients who have undergone corneal transplant surgery. Even meticulous surgery performed by the best of surgeons cannot guarantee visual rehabilitation unless supplemented by the very critical component of postoperative care. Early recognition and institution of prompt treatment of complications of corneal transplantation go a long way in increasing the success rate of this surgical procedure. Even though corneal transplantation is not performed by all ophthalmologists, familiarity with the postoperative care is needed to provide the follow-up care to ensure its success. This is a lifelong necessity for a transplant recipient. Saini in his article clearly defines the postoperative management and highlights the critical issues regarding corneal transplantation.
Early recognition and prompt treatment of complications such as graft rejection, glaucoma and infection can significantly improve the success rate of corneal transplantation even in our country. A multipronged approach is needed to combat corneal blindness. Quality of donor cornea, surgical procedure and postoperative care together determine the success of corneal transplantation and consequent visual rehabilitation of the corneal blind.