Specializing in complex cases and previous complications of corneal surgery, Dr. Rapoza is an experienced surgeon who has been instrumental in developing surgical techniques for various types of corneal surgery, including corneal transplants.
Cornea surgery may be considered minor or major depending on the medical issue. Examples of minor procedures include pterygium removal or superficial keratectomy. A major corneal operation is a corneal transplant.
Minor Corneal Procedures
Corneal Epithelial Debridement
Corneal Epithelial Debridement is performed to remove loose surface tissue from the cornea. This in-office treatment, involves gentle rubbing of the cornea with a device that polishes the under-surface. Once the new surface layer grows back, it firmly attaches to the cornea and reduces the risk of recurrent poor adhesion and pain.
Superficial Keratectomy
Superficial Keratectomy is an in-office procedure that removes the defective surface layer from the cornea, so that healthy cells can regenerate naturally from the edges of the cornea. This is commonly performed on patients who have ocular surface diseases, including erosion of the cornea and Anterior Basement Membrane Dystrophy.
Removal of Pterygium and Pinguecula
Pinguecula are growths that develop over the white of the eye while pterygia are extensions of pinguecula that actually grow over a variable area of the cornea, sometimes causing astigmatism or obscuring vision. Both types of growths are believed to be caused by dry eye and environmental elements such as wind, dust and ultraviolet (UV) light. Dr. Rapoza may prescribe eye drops to relieve some of the discomfort associated with these lesions or recommend the surgical removal of the lesions if the conditions remain problematic
Punctal Plugs for Dry Eye
Sometimes it is neccesary to close the ducts that drain tears out of the eye in order to treat symptoms of dry eye. Plugs can be inserted to achieve better lubrication of the eyes.
- Temporary punctal occlusion: Temporary plugs can be inserted into the tear drain of the lower eyelid to determine if this helps provide adequate tears. These plugs can be removed or may be dissolvable within a few days.
- Semi-permanent punctal occlusion: If the temporary plugs work well, Dr. Rapoza may suggest permanent, yet removable, plugs. The goal is to provide adequate tears and lubrication, improve patient comfort and reduce the need for artificial tears. In rare cases the plugs may come out spontaneously or migrate down the tear drain.
- Permanent punctal occlusion: In cases of more severe dryness, cauterization of the tear drain completely closes the tract and can provide better lubrication for the eye.
Major Corneal Procedures – Corneal Transplants
Dr. Rapoza is sub-specialty trained and is highly qualified to provide consultations, second opinions and treatments for a wide variety of corneal problems including corneal transplants.
The cornea is the clear, thin tissue at the front of the eye, through which light passes on the way to the retina. Corneal Transplants involve replacing damaged or diseased cornea with a donor cornea from an eye bank so better vision can be achieved. Dr. Rapoza performs the following types of corneal transplants:
- Penetrating Keratoplasty (PK): Full-thickness corneal transplant that replaces a larger round section of cornea
- DSAEK: Partial-thickness corneal transplant placed onto the back surface of the cornea using a small incision
A corneal transplant is performed for various corneal conditions, such as:
- Eye injury
- Keratoconus, an abnormal steepening of the curvature of the cornea
- Corneal failure as a result of eye surgery
- Scarring of the cornea after trauma or infection
- Inherited eye disorders (corneal dystrophies)
- Rejection after prior corneal transplant
Cornea transplantation is a one of the most successful and frequent transplant operations performed, partly because of a low rejection rate. It is estimated that approximately 50,000 corneal transplants are performed each year in the United States. While success rates have risen dramatically over the years, there are still possible complications that can occur, including:
- Rejection of the transplanted cornea
- Eye redness
- Pain
- Sensitivity to light
- Decreased vision