The Best Cornea Doctor in Egypt

Were you searching for information about keratoconus and have you recently been diagnosed with keratoconus yourself or heard about this diagnosis from a relative?

Do you want to know all the details about this disease, its causes, treatment methods, and more?

If your answer is “yes” to these questions, then you are in the right place. We, at Dr. Ahmed Al-Najjar’s clinic, have gathered all the information about this disease, its proper treatment, in a detailed and simplified manner to explain it to everyone. Follow along to the end to learn all the details.

Dr. Ahmed Al-Najjar is considered the best doctor for treating keratoconus and corneal transplantation in Egypt and the Arab world. He is a consultant in ophthalmology and eye surgery and one of the most distinguished doctors in the field of corneal transplantation and the treatment of keratoconus.

What Is Keratoconus?

The normal and natural shape of the cornea of the eye is spherical. The cornea consists of several highly transparent layers that allow the passage of light rays into the eye and translate them into a visible image that we can see. However, when keratoconus occurs, thinning occurs in the central area of the cornea through which the light ray passes. This thinning leads to a slight protrusion of the cornea or what is called corneal ectasia due to its decreased thickness. This, in turn, results in the condition of keratoconus, where the quality of vision and eyesight deteriorates, and the patient suffers from various complications and side effects, which will be mentioned later.

What Are the Symptoms of Keratoconus?

There are many signs and symptoms that warn you of keratoconus and indicate the need to see a doctor to ensure the health of your eyes. Some of these signs and symptoms include:

• – Blurred and distorted vision
• – Difficulty in perceiving near and distant objects
• – Inability to drive at night
• – Intolerance to bright and glaring light
• – Chronic headaches

One of the most important symptoms of keratoconus in children is the need to change prescription glasses very frequently.

Complications of Neglecting Keratoconus:

Delaying treatment can lead to the appearance of unwanted symptoms and consequences that the patient would have been better off without if the patient had undergone the procedure early. These complications include:

1. Noticeable swelling of the cornea of the eye.
2. Rapid and surprisingly severe deterioration in visual quality.
3. Injury to the innermost layer of the cornea.
4. Observation of clouds or haziness in the patient’s field of vision.
5. The development of corneal ulcers and scarring, which are the most dangerous stages of keratoconus and cause irreversible damage.

When Is Corneal Transplantation Necessary?

There are exceptional cases and special circumstances in which a patient needs surgery as soon as possible because delaying treatment for an extended period can ultimately lead to partial or complete vision loss. These emergency cases include:

1. Patients in whom keratoconus has progressed to the point of severe scarring and ulcers.
2. Patients who have undergone previous eye surgeries that were unsuccessful due to the surgeon’s lack of competence or other patient-related factors.
3. Patients with genetic diseases, such as those with Vogt-Koyanagi-Harada (VKH) disease.
4. Patients who have developed corneal swelling and edema after neglecting treatment for extended periods.

What Is the Treatment for Keratoconus?

There are several old and modern treatment methods used to address keratoconus. Each of them has its advantages and characteristics that differ from the others, but they all share a common goal: to halt the deterioration of keratoconus and restore normal vision for the patient. Some of these treatments include:

1. Prescription Glasses:Similar to how prescription contact lenses are used, prescription glasses correct vision problems and help restore the ability to see with the best possible quality. They are suitable for cases of mild to moderate keratoconus.
2. Corneal Ring Implantation:This is a recent and highly successful procedure in which rings are implanted in the cornea to correct its topographical shape. It helps flatten the irregular surface and is suitable for moderate cases.
3. Corneal Collagen Cross-Linking:This procedure can be either therapeutic or supportive. It can permanently correct vision or serve as a follow-up procedure to prevent relapse. In this procedure, ultraviolet rays are directed into the cornea, and riboflavin is applied to enhance collagen bonds in the cornea, stabilizing it and preventing further deterioration. This is suitable for early-detected keratoconus.
4. Photorefractive Keratectomy (PRK):This technique can be applied to treat keratoconus under certain conditions, with the primary requirement being a highly experienced surgeon and a sufficient thickness of the cornea. PRK uses laser beams to correct corneal irregularities and deformities and can be combined with corneal collagen cross-linking.
5. Corneal Transplantation:Corneal transplantation is the last treatment option used by many eye doctors when all other therapeutic solutions have been exhausted. It is a secure and highly successful solution in 99% of cases. There are different types of corneal transplantation, including:
   • Penetrating Keratoplasty (PKP): Replacing all layers of the cornea.
   • Deep Anterior Lamellar Keratoplasty (DALK): Replacing some layers of the cornea, often used in genetic diseases.
   • Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK): Replacing the posterior layer of the cornea.

   Corneal transplantation is recommended when the cornea is severely damaged, showing scarring or ulcers, and it requires several months for recovery due to the surgical grafts used to stabilize the new cornea.

It’s worth noting that while these treatments can yield excellent results, there is a potential for regression in some cases. Therefore, careful consideration of the patient’s condition and consultation with an experienced ophthalmologist are essential to determine the most suitable treatment approach.

Corneal Transplantation

Corneal transplantation is the last resort treatment that many eye doctors turn to when all other treatment options have been exhausted. Corneal transplantation is a highly reliable, safe, and successful solution in 99% of cases. There are several types of corneal transplantation, including:

1. **Penetrating Keratoplasty (PKP):**

In this procedure, all layers of the cornea are replaced with healthy artificial layers taken from a recently deceased donor. This procedure is only performed in cases where the cornea is severely damaged, such as in cases of ulcers or severe external injuries. The recovery period can take several months because surgical grafts are used to secure the new cornea, prolonging the healing process.

2. **Deep Anterior Lamellar Keratoplasty (DALK):**

In this type, only some layers of the cornea, specifically the back layers deep within the cornea, are replaced. It is commonly used in cases of genetic diseases, such as in patients with Vogt-Koyanagi-Harada (VKH) disease. There are two subtypes:

• – **Type 1: Descemet’s Membrane Endothelial Keratoplasty (DMEK):** In this subtype, Descemet’s membrane and the endothelial layer of the cornea are transplanted without relying on the use of the stroma (stromal tissue) because the corneal tissues are fragile and thin, and any human error can lead to vision loss. This procedure is known for its short recovery period and quick results.
• – **Type 2: Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK):** This procedure involves the removal of the endothelial layer of the cornea, typically the posterior stroma, and its replacement with healthy donor tissues. The surgeon may use the Descemet’s membrane to simplify handling of the newly transplanted tissues.

3. **Deep Anterior Lamellar Keratoplasty (DALK):**

This procedure involves removing only the anterior and middle layers of the cornea and replacing them with new layers from a recently deceased donor, adhering to strict conditions. In this procedure, an airstream is directed toward the cornea at a carefully calculated angle to separate the corneal layers, making them easier to handle. Although this procedure yields excellent results, there is a potential for regression.

Corneal transplantation is considered when the cornea is severely damaged, showing scarring or ulcers. Recovery from corneal transplantation can take several months, and the choice of procedure depends on the specific condition and characteristics of the patient.

Preparation Before Corneal Transplantation

Before undergoing corneal transplantation, it is important to take precautions and follow the instructions provided by the doctor in the days leading up to the procedure to ensure its success, ease, and safety. Some necessary steps include:

1. Preoperative Examination: Visit the doctor shortly before the procedure for a comprehensive eye examination to ensure the stability of your eye condition.
2. Medical Tests: Do not skip any laboratory tests requested by the eye doctor. These tests help identify any potential issues that could arise during the procedure. Examples include tests for bleeding time, clotting time, and others.
3. Medication Compliance: Take the medications prescribed by the doctor regularly and adhere to the dosage schedule without any deviations. Some medications, such as anticoagulants, may need to be temporarily discontinued.

Post Corneal Transplantation Care Tips

After undergoing corneal transplantation, you will need to pay extra attention to your health to avoid any unwanted complications or damage to the transplant. Here are some important tips to follow:

1. Eye Drops: Do not neglect the eye drops prescribed by your eye doctor. Take them as directed to prevent eye infections and inflammation.
2. Avoid Intense Physical Exercise: Refrain from engaging in strenuous physical activities that could negatively affect the site of the transplanted cornea.
3. Avoid Rubbing or Pressing Your Eyes: Avoid touching or rubbing your eyes, as this could damage the transplanted cornea.
4. Use Protective Eye Shield: Use an eye shield before sleeping to protect your eye and prevent accidental damage.
5. Avoid Dusty or Polluted Areas: Stay away from dusty or polluted environments to prevent eye infections caused by bacteria and viruses, as the eye is highly sensitive during this period.

What Are the Complications of Corneal Transplantation?

When a patient does not adhere to the instructions given before and after the surgical procedure, there is a possibility of experiencing complications resulting from neglect or unforeseen circumstances. Among these complications, we mention:

1. Viral/Bacterial Eye Infections: Infections of the eye caused by viruses or bacteria can occur if the patient does not follow proper care instructions.
2. Eye Bleeding: Eye bleeding can happen as a result of trauma or other factors during or after the procedure.
3. Elevated Intraocular Pressure: Increased pressure within the eye can lead to complications.
4. Appearance of “Haze” or Cataracts: Cloudiness or haze in the eye, or the development of cataracts, can affect vision.
5. Corneal Swelling and Edema: Swelling and fluid buildup in the cornea can impact vision.
6. Retinal Detachment: In some cases, retinal detachment may occur.
7. Immune Rejection of the New Cornea: The immune system may recognize the transplanted cornea as foreign tissue and attempt to reject it.

Success Rate of Corneal Transplantation

The success rate of corneal transplantation at Dr. Ahmed Al-Najjar’s center exceeds 95% or more. This high success rate is expected and very realistic because the procedure is performed under the personal supervision of Dr. Ahmed, who is one of the leading eye specialists in the country. In addition to that, strict safety measures are followed, and the latest equipment and techniques are used to ensure the success of the procedure.

Signs of Immune Rejection of the Transplanted Cornea

The new cornea that will be transplanted into the eye is considered an external foreign body by the immune system. Therefore, the doctor takes all necessary precautions to ensure biological and enzymatic compatibility to prevent immune rejection. However, there are cases beyond control where immune rejection occurs when the immune system views the new cornea as a foreign substance that needs to be eliminated. Unfortunately, this condition cannot be entirely avoided, but there are clear signs indicating the seriousness of the patient’s condition and the occurrence of immune rejection, such as:

1. Redness and swelling of the eye.
2. Discomfort in bright light.
3. Partial or complete loss of vision in advanced cases.

Despite this, there are several ways to treat immune rejection, including prescribing immunosuppressive drugs to the patient, performing a new corneal transplant, or removing the cornea that is incompatible with the patient’s tissues.

Duration of Corneal Transplantation

The duration of a corneal transplantation procedure typically ranges from half an hour to a full hour. This depends on various factors, including:

• The degree of keratoconus.
• The severity of corneal damage.
• The type of anesthesia used (local or general).
• The skill and experience of the surgeon.
• The specific surgical technique employed.

What Is the Solution If the Expected Visual Quality Is Not Achieved?

In some cases, despite corneal transplantation being performed by top doctors in advanced eye centers, a patient may find that their vision has not improved as expected following the procedure. While this situation is very rare and exceptional at Dr. Ahmed Al-Najjar’s center, it is still possible. When it occurs, certain investigative measures are taken:

1. Confirmation of Corneal Ectasia: The doctor will assess whether the patient has developed corneal ectasia, which is a possible but rare complication. During corneal transplantation, the corneal surface can be scratched when surgical sutures are placed to secure the new cornea. In such cases, the doctor may adjust the tension of the sutures in a specific way to accommodate the patient’s condition and comfort.
2. Correction of Refractive Vision Problems: Refractive vision issues like nearsightedness or farsightedness can be addressed with prescription eyeglasses or contact lenses to mitigate the severity of the condition.

Can Keratoconus Be Completely Cured?

Keratoconus is characterized by its inability to be fully reversed. This means that the conical shape of the cornea is challenging to correct and return to its natural state. Therefore, all treatments aim to minimize the deterioration of vision and improve it as much as possible. Ongoing research and scientific studies in the field of ophthalmology are still underway to find an appropriate therapeutic solution for keratoconus.

Does Keratoconus Cause Blindness?

Some patients may believe that their keratoconus will inevitably lead to blindness. However, there is no conclusive evidence to support this, and there is no direct link between blindness and keratoconus. However, if the eye is affected by severe and chronic diseases, it can be influenced by multiple conditions and may lose partial visual acuity.

Best Cornea Doctor in Egypt

We all desire to work with a doctor who understands the patient’s concerns and feelings, helps them overcome these fears, explains complex procedures in a simple manner, and discusses all details without exception. Fortunately, there is indeed a doctor who possesses all of these qualities, and that is Dr. Ahmed Al-Najjar, a specialist in ophthalmology and its surgeries. With him, you will experience courteous treatment, understanding of all patient concerns, a highly experienced and skilled surgical hand, continuous patient follow-up, and care even after the surgery. This is attested to by all of Dr. Ahmed’s patients and colleagues. It is the expected result of his continuous pursuit, diligent work, and ongoing efforts over many years, which, with the grace of God, have earned the trust of thousands of patients. His medical clinics have become a center of attraction for eye patients from all over the world.

With these positive opinions about the renowned Dr. Ahmed Al-Najjar, we conclude today’s article in which we discussed the case of keratoconus, which has become a prevalent condition in the present era. We also highlighted corneal transplantation as a commonly adopted therapeutic measure in this condition. We hope you have enjoyed our discussion, and may you all be in good health.