Dr Agarwals Eye Hospital Averts Corneal Transplant; Treats Senior Citizen’s Damaged Cornea with Pinhole Pupilloplasty
Pioneered by Prof. Dr. Amar Agarwal in 2018, pinhole pupilloplasty has been used to treat corneal scarring, opacities, and high astigmatism
The surgical team combined pinhole pupilloplasty with multiple surgical procedures, including corneal and scleral repair, as well as the repositioning of intraocular tissues, all performed in a single sitting.
Marking a breakthrough in advanced ophthalmic care, Dr Agarwals Eye Hospital successfully performed a complex surgical intervention that combined pinhole pupilloplasty (PPP) with corneal and scleral repair to restore the vision of a senior citizen who sustained severe injuries in his right eye while playing badminton. The emergency intervention successfully avoided the need for corneal transplantation, significantly reducing the risks of infections and graft rejection while ensuring a safer and more effective vision restoration.
The integration of Pinhole Pupilloplasty (PPP) with multiple surgical procedures, including intraocular tissue repositioning and artificial lens implantation to address the patient’s pre-existing cataract, is a rare and complex intervention. Led by Prof. Dr. Amar Agarwal, Chairman of Dr. Agarwals Eye Hospital, the surgery lasted approximately an hour. Following the procedure, the patient completely regained his vision, and the wound is healing well.
Introduced by Prof. Dr. Amar Agarwal in 2018, Pinhole Pupilloplasty (PPP) is a technique designed to reduce the pupil size to that of a pinhole, limiting the amount of light entering the eye. This ensures that images focus sharply on the retina, thereby enhancing the patient’s visual acuity. Traditionally, PPP has been used primarily for the treatment of high astigmatism. People with conditions like keratoconus, post-pterygium excision, and post-corneal tear repair, can experience significant improvement in their quality of vision following Pinhole Pupilloplasty.
Addressing a press conference, Prof. Dr. Amar Agarwal, Chairman, Dr Agarwals Eye Hospital said the patient, Mr. Mani, 67 years old, suffered a severe injury to his right eye, with complete corneal damage. In such cases, corneal transplantation would typically be performed, requiring donor cornea from a cadaver. Transplantation typically involves multiple sutures, increasing the risk of infection and long-term complications. “However, we opted for a full-thickness repair of the cornea and sclera—the frontal parts of the eye—repositioned the prolapsed intraocular contents, and implanted an artificial lens to treat the pre-existing cataract. Since patients who undergo corneal tear repair often experience visual deterioration due to high astigmatism and corneal aberrations, we combined the procedure with Pinhole Pupilloplasty. All these interventions were performed in a single sitting, ensuring a comprehensive and effective solution for vision restoration.”
In his comments, Dr Ashvin Agarwal, Chief Clinical Officer, Dr Agarwals Eye Hospital said, “Over 54% of ocular emergencies and 32% of blindness cases in India result from trauma, often leading to corneal scarring, opacities, and astigmatism, which cause vision loss or blurring. In severe cases, corneal transplantation is typically performed. However, even after a transplant, vision impairment may persist. Pinhole Pupilloplasty (PPP) has emerged as a groundbreaking alternative for many patients. It requires no additional equipment, is easy to learn, and significantly reduces surgical costs. PPP is particularly beneficial for conditions such as corneal scarring and opacities that would otherwise require full-thickness corneal grafting. Additionally, patients with high astigmatism—such as those with keratoconus, post-pterygium excision, or post-corneal tear repair—can achieve significant improvements in their visual quality through this procedure.”
In her comments, Dr. S. Soundari, Regional Head – Clinical Services, Dr Agarwals Eye Hospital , said that the cornea plays a crucial role in focusing vision, but it can be damaged due to various factors, including injuries, exposure to explosions, complications after eye transplantation or surgery, or conditions like keratoconus, a conical deformity of the cornea. The patient had suffered corneal and scleral tears along with a prolapse of intraocular tissues in his right eye. He was admitted to the hospital with severe pain and vision loss. However, we combined the repair of torn corneal and scleral layers, cataract surgery, and PPP in a single sitting, eliminating the need for multiple procedures. Thanks to PPP, corneal transplantation was also avoided. Following the surgery, he is recovering well and doing extremely well