Eye diseases affect many people worldwide and can have severe impacts on quality of life and function. Fortunately, numerous eye conditions, including cataracts, glaucoma, and corneal injury, now have the option of surgical treatment.

Cataracts are the leading cause of preventable blindness in the developing world. It is an age-related disease that requires the opaque natural lens to be excised and replaced with an artificial intraocular lens (IOL). Phacoemulsification and Femtosecond-assisted Laser Cataract Surgery are improved techniques for cataract surgery. However, they are expensive; lower-cost options include Manual Extracapsular Cataract Extraction or Manual Small-Incision Cataract Surgery. While the more expensive surgical interventions eliminate the need for sutures, significantly reducing postoperative complications, the lower-cost options require larger incisions and sutures in the delicate eye.

Glaucoma, another well-known eye disease, is one of the conditions with surgical treatment options. Patients develop glaucoma when fluid accumulates in the eye. Surgical interventions drain the fluid. The first option is trabeculoplasty, a laser surgery that improves the drainage angle in the eye. If natural drainage remains insufficient, then a trabeculectomy is performed. In this procedure, surgeons create a small incision in the sclera, allowing the aqueous humor to drain. In more severe cases, a drainage implant, which creates a special reservoir for the humor to drain from the eye, may be needed.^1,3

Several other eye conditions require multi-stage surgical intervention for successful treatment, such as autoimmune thyroid eye disease, which causes hypertrophy of the extraocular muscles and increases intraorbital fat. Symptoms include bulging eyes, optic nerve compression, double vision, and eyelid retraction. The first stage is orbital decompression, which removes excessive fat. Then, strabismus surgery is performed to change the length of the eye muscles to rectify double vision. Finally, blepharoplasty or eyelid surgery is performed to restore the eyelid.²

One of the more complex eye conditions to treat is cornea damage. In some cases, a full-thickness corneal transplant may be needed to replace the damaged organ with a donor cornea. During a full-thickness procedure, penetrating keratoplasty is typically required for advanced keratoconus patients, Fuchs dystrophy, and corneal ulcers. When possible, it is preferred to perform a partial thickness corneal transplant to excise only damaged tissue and salvage healthy organs. Non-genetic conditions such as swelling, infection, and other external damage to the eye can bring patients into the operating room for this type of surgery as well. In some cases, the cornea’s innermost layer is damaged, requiring endothelial keratoplasty. In this surgery, the superficial removal of the cornea’s innermost layer is performed to improve conditions such as Fuchs’ dystopia, bullous keratopathy, iridocorneal endothelial syndrome, and other endothelial disorders.³

Severe dry eye, neurotrophic or neuroparalytic disease, and bullous keratopathy require treatment to improve the integrity of the corneal surface and prevent gradual ulceration. Conjunctival flap surgery can reduce the need for a corneal transplant in the long term. Immediate benefits include pain relief and reduced dependence on topical medications.  This surgical technique involves removing the corneal epithelium and reinforcing the thinning corneal and scleral tissue while constructing a mobile conjunctival flap that contains a minimal Tenon capsule. This treatment was explored for peripheral ulcerative corneal diseases associated with autoimmune disorders such as Mooren’s ulcer, peripheral ulcerative keratitis caused by granulomatosis with polyangiitis (formerly known as Wegener’s granulomatosis), and rheumatoid arthritis.

Fortunately, surgical and non-surgical treatment options are available for many eye conditions. However, the inaccessibility of many options to low-income patients due to high costs remains an issue.⁴

References

1. Moshirfar, Majid, et al. “Cataract Surgery.” StatPearls – NCBI Bookshelf, 18 July 2023, ncbi.nlm.nih.gov/books/NBK559253.
2. Pillar, Angelique J., and D. Chimene Richa. “Treatment Options for Thyroid Eye Disease.” Current Treatment Options in Neurology, vol. 16, no. 8, June 2014, doi:1007/s11940-014-0303-8.
3. “Types of Eye Surgery: A List of Vision Correction Procedures | MyVision.org.” org, 26 Feb. 2022, myvision.org/eye-surgery.
4. Zemba, M., et al. “Conjunctival Flap Surgery in the Management of Ocular Surface Disease (Review).” Experimental and Therapeutic Medicine, July 2020, doi:3892/etm.2020.8964.