Corneal Transplantation (DALK)

Why do you need a corneal transplant?

The cornea is a window of transparent tissue at the front of the eyeball. It allows light to pass into the eye and provides focus so that images can be seen. Various diseases or injury can make the cornea either cloudy or out of shape. This prevents the normal passage of light and affects vision. The cornea has 3 layers (thin outer and inner layers and a thick middle layer). In some diseases, only the middle layer or part of the middle layer is affected (see below).

DALK is a modern technique whereby the outer two layers of the cornea are removed and replaced with the outer 2 layers from a donor cornea to give a partial-thickness transplant.

Benefits of Deep Anterior Lamellar Keratoplasty

Improved vision

  • 90% of transplant recipients reach driving standard if the eye is otherwise healthy but can need glasses or contact lenses or sometimes further surgery for best results.
  • It may take up to 18 months until the full improvement in vision is appreciated.

Risks of Deep Anterior Lamellar Keratoplasty

Rare but serious complications

  • Sight-threatening infection (1 in 1000)
  • Severe haemorrhage causing loss of vision
  • Retinal detachment

Corneal transplant rejection

A corneal transplant can be identified and attacked by your immune system. This happens in less than 10% of DALK recipients in the first two years after transplantation and can cause graft failure. It can often be reversed if  anti-rejection medication is started promptly. Rejection remains a possibility for your lifetime.

Graft Failure

When a graft fails the cornea becomes cloudy again and vision becomes blurred.


This can usually be controlled by eyedrops but occasionally requires surgery.


This can be removed surgically. Conversion to penetrating keratoplasty. Occasionally it is not possible to perform a partial thickness transplant and a full-thickness transplant must be performed instead. This happens in 10% of intended DALK procedures.

Possible advantages of DALK over full-thickness graft

  • Lower risk of intraocular problems such as serious infection or bleeding.
  • Lower risk of graft rejection.
  • The corneal wound after DALK is stronger than that after a full-thickness graft (PK). This means that stitches can be removed sooner.

Possible disadvantages of DALK over full-thickness graft

DALK recipients have a slightly lower chance of achieving 6/6 vision (excellent vision) than recipients of full thickness grafts.

About the operation

The Operation

The operation is performed under general or local anaesthetic. The operation takes about one hour. A central partial thickness 8mm button of the patient’s cornea is removed and a similar-sized button of the donor cornea is stitched in with tiny stitches (see front cover). These cannot be felt nor seen. The abnormal cornea, which is removed is sent to our pathology laboratory for examination under a microscope.After the operation

After the operation you will usually be examined by the surgical team after the surgery and can usually go home the same day. You will be seen again within 1 week in the outpatient clinic and regularly thereafter (approximately 6 visits in the first year). We generally recommend that you take 2 weeks off work – discuss your case with your doctor. You will need to use anti-rejection eyedrops for at least 6 months and in some cases indefinitely. Individual stitches may be removed from 3 months after the operation but complete stitch removal is not performed until at least 1 year.

What if my transplant fails?

A failed transplant can be replaced in a procedure known as a regraft. However the risk of subsequent rejection and failure increases each time for second and subsequent regrafts.Corneal Transplant Rejection

If not treated urgently this can lead to failure of the transplant and loss of vision.

Symptoms of rejection are:

  • Red eye
  • Sensitivity to light
  • Visual loss
  • Pain

If you experience any of these symptoms, you should immediately call our 24-hour emergency phone line 055 516 1586.

Cataract Surgery Treatment


The term cataract derives from the view we get when looking through a waterfall.

  • A cataract is the clouding or opacity of the lens inside the eye. The lens has the shape of a lentil and lies behind the coloured part of the eye, the iris.
  • In a normal eye, this lens is clear. It helps focus light rays on to the back of the eye, the retina, which sends messages to the brain allowing us to see. When a cataract develops, the lens becomes cloudy and prevents the light rays from passing to the retina.
  • Cataracts usually form slowly and people experience a gradual blurring of vision.

“I didn’t know that I had a cataract until my doctor told me!”
Some people may not be aware that a cataract is developing. It can start at the edge of the lens and initially may not cause problems with vision. Generally, as cataracts develop, people experience blurring or hazing of vision. Often they become more sensitive to light and glare.
I seemed to have to go to the optician more to get new glasses.
There may be a need to get new prescriptions for glasses more often when a cataract is developing. When cataracts worsen, stronger glasses no longer improve sight. Objects have to be held close to the eye to be seen. The hole in the iris, the pupil, may no longer look black. It may instead look white or yellow.

Questions & Answers

Do cataracts spread from eye to eye?
No. But often they develop in both eyes at the same time.

Has my cataract been caused by overuse of my eyes?
No. Cataracts are not caused by over use of the eyes and using the eyes when the cataracts start will not make them get worse.

Are there different kinds of cataract?
Yes. Cataracts can be caused by injuries to the eye. This type of cataract is called a traumatic cataract.

Can children have cataracts?
Yes. Babies can be born with this condition. This is called congenital cataract.

Is there a link between diabetes and cataracts?
Yes. Cataracts are more common in people who have diabetes.

Are cataracts just a part of getting old?
Most forms of cataract develop in adult life. The normal process of ageing causes the lens to harden and become cloudy. This is called age-related cataract and it is the most common type. It can occur at any time after the age of 40.

When do I have my cataract treated?
When the cataract progresses to the point that it is interfering with daily activities and normal lifestyle, cataract surgery is usually the next step. Cataracts don’t grow back after surgery.

Could anything have been done to stop me developing a cataract?
There is no known prevention for cataract. Advanced modern cataract surgery using a small incision is highly successful for the great majority of patients.

Are cataracts removed by laser?
No. Surgery is the only effective way to remove a cloudy lens. It is removed with highly sophisticated state of the art equipment available at Moorfields Eye Hospital Dubai.

I have a cataract developing in both eyes, are both treated at the same time?
No, the second eye is operated on a few weeks later.

Do I need any special tests before the operation?
Yes. We will carry out precise measurements of the eyes. Here at Moorfields Hospital we use the IOL Master, one of the most accurate instruments available at this time.

What kind of anaesthetic is necessary?
Most operations for cataracts are performed under local anaesthetic, drops alone or anaesthetic around the eye. You will be awake during the operation and aware of a bright light, but you will not be able to see what is happening. Occasionally a sedative agent is given to make you feel more relaxed. General anaesthesia is seldom necessary.

Will I have to stay in hospital?
No. All routine operations for cataracts are performed on a day care basis. This means you are admitted to hospital, have your operation and are discharged in the same day.

What does the operation involve?
Modern small incision cataract surgery at MoorfieldsisperformedwithPhac-oemulsification. This technique uses sound waves to soften the lens, which is then removed through a small tube. The natural Lens is replaced with an Artificial Lens also called IOL.The operation takes between 10-20 minutes.

Are there any complications?
There are some possible complications during the operation such as:

  • Tearing of the back part of the lens capsule

This is however rare and should be less than 1/1000 in experienced hands.

  • Inflammation of the eye

The eye may become red and ache. This is a condition called uveitis and can be treated effectively with drops.

  • Blurring of the central vision

An accumulation of fluid in the back of the eye (retina) may occur, causing blurring of the central vision. This is known as cystoid macular oedema. This usually resolves itself within a few weeks.
Serious complications are uncommon following cataract surgery. However, like any kind of operation, problems can occur.
After the operation problems with infection and inflammation can present a few days later. If you experience any of the following contact us immediately:

  • Pain
  • Light sensitivity
  • Red eye

Questions & Answers

Will my eyes need to be covered following the surgery?
Your eye will be covered with a protective plastic eye shield. Some patients may also have an eye pad.

Will I feel any pain after the operation?
As the anaesthetic wears off, there can be a dull ache felt inside and around the eye. You can take paracetamol or other general painkillers that suit you best.

Can I bend down to pray?
Yes, from the following day but you have to be very careful not to injure your eyes or apply any pressure on them.

When will the doctor see me after the operation?
The doctor will see you the day after the operation.

How do I put the eye drops?
A nurse will teach you how to look after your eyes before you are discharged. You will be shown how to clean your eyes and put in the eye drops correctly. Eye drop treatment prevents infection and helps reduce.

Is there anything else I have to do to care for my eye?
You should avoid rubbing or touching your eye. You may find you are sensitive to light, so it is useful to have a pair of plain dark glasses in case you need them. The majority of patients can resume normal physical activity within a week. You should be able to return to work the day following your operation depending on your job, check with the doctor to confirm.

Will I need glasses?
Generally, you will still need glasses for reading and occasionally for distance. You can also choose to have a MULTIFOCAL or an ACCOMODATIVE lens inserted to improve your unaided near vision.
Usually you will have a check-up for your glasses with our Optometrist after 4 weeks. If you would prefer not to depend on the glasses for near vision ask your surgeon about what is available.

Will the lens implant last forever?
Yes. However, 1 in 10 patients will have a thickening of the membrane behind the new lens. This occurs in the months or years following surgery. This is called capsular opacity, and can be effectively treated with the YAG laser in the hospital.



  • Common condition that causes inflammation of the eye lids and can affect people of all ages.
  • It usually affects the rim of the eyelids of both eyes and usually is not serious but still irritating and uncomfortable.
  • Eyelids may become crusty and scaly and eyes may feel gritty and very tired with increasing irritation when outdoors in sunshine or around any polluted or smoke filled environment.
  • Can be associated with skin conditions such as rosacea and eye conditions like conjunctivitis.
  • The symptoms can re-occur at any time but home treatment can calm the symptoms and eyesight is generally not affected.


You might be prescribed a combination of treatments described below depending on the type of blepharitis: anterior or posterior.

Cleaning of the lid margin

Dip a clean cotton bud in the solution* and clean away any crusts present on the eyelashes. A mirror may be helpful. Do not clean inside the eyelids as this will make them sore. Repeat the process twice a day.
Wipe along the Lid Margin


  • Bicarbonate of soda
  • Baby shampoo solution
  • Normal saline
    Use the antibiotic
  • Hot compresses
    Soak a clean gauze in boiled water and hold it on your lids with your eyes closed, for 5 minutes twice a day, being careful that the temperature is not too hot.
  • Lid massage
    Roll your finger/cotton bud towards the margin 10 times each for the top and bottom lid, twice a day.
  • Antibiotic drops
    Apply as directed by pulling the lower lid off the eyeball and letting the drop fall into the pocket without touching the lid.
  • Antibiotic ointment
    Apply as directed, by squeezing 1 cm out of the tube onto your index finger and rubbing it onto the lid margin. It is very important that you follow the instructions in the order shown above.

Top lid, roll downwards
Bottom lid, roll upwards
You must be careful not to touch the eyeball with the cotton bud.

Atropine Drops

What are the effects of Atropine?

Atropine has two effects when instilled in the eyes:

  • Dilates the pupil (makes the black part of the eye larger).
  • Stops the eye from focusing properly – blurring the child’s near vision temporarily.

Why has my child been prescribed Atropine?
Atropine has been prescribed to enable an eye care specialist to check the back of your child’s eyes andto determine if glasses are required. Atropine drops / ointment may be used when:

  • A child’s eyes have failed to dilate sufficiently with Cyclopentolate drops used in the clinic.
  • Your child has very dark coloured eyes; the additional pigmentation makes dilation more difficult.

Atropine can also be used on occasion to help ‘relax’ your child into their new glasses or to treat amblyopia (lazy eye).



  • Astigmatism is a treatable eye condition that can cause blurred vision and headaches.
  • It is a refractive condition in which the eye’s optical system is incapable of forming a point image for a point object (images are misconstrued).
  • The refractive error of the astigmatic eye stems from a different degree of refraction in different meridians; for example, the image may be clearly focused on the retina in the horizontal plane, but not in the vertical plane, or not on the retina in either plane.
  • It occurs when the front surface of the eye is uneven; an irregular shaped cornea or lens prevents light from focusing properly on the retina, the light sensitive surface at the back of the eye. As a result, vision becomes blurred at any distance.

What are the symptoms?

Severe astigmatism:

  • Vision blurred or distorted whether the person is reading close up or looking further into the distance.

Mild astigmatism:

  • Vision blurred at certain distances
  • Tired or dry eyes
  • Struggle to focus or read
  • Headaches, especially when trying to focus

How is it diagnosed?
Astigmatism should be diagnosed by a qualified Optometrist and/or Ophthalmologist.
A full optometric examination should be done to assess the degree and extent of the problem.
Small children, who may not be able to answer the optometrist’s questions about what they can see, can be assessed using a test called retinoscopy that involves reflected light.
What is the treatment?
In most cases, astigmatism can be corrected by wearing properly fitted spectacles or contact lenses.
Milder astigmatism may not need treatment unless the person has a job that strains their eyes, for example, computer work.
In some cases, astigmatism can be corrected by laser surgery which reshapes the cornea.

Aqueous Shunts

Aqueous shunts are devices that are used to reduce the eye pressure in glaucoma by draining the aqueous humour (natural fluid of the eye) from inside the eye to a small blister or bleb behind the eyelid.
Draining the aqueous humour, using a shunt, reduces the pressure on the optic nerve that causes loss of vision in glaucoma. The purpose of lowering the eye pressure is to prevent further loss of vision. Control of the eye pressure with an aqueous shuntwill not restore vision already lost from glaucoma.
Aqueous shunts have various other names such as tube implants, glaucoma tube shunts, glaucoma drainage devices and glaucoma drainage implants. These all refer to the same thing. Although there are many types of shunts available, two main typesare in use at Moorfields Eye Hospital Dubai and they function in a similar fashion.
These are called the Ahmed Glaucoma Valve and The Baerveldt Glaucoma Implant.

Amblyopia Therapy

What is Amblyopia?

Lazy eye – the medical term is Amblyopia – is a common eye condition amongst younger children. It means that one eye is not developing properly and becomes ‘lazy’ because the brain is working harder with the good eye to compensate. The problem is that if the brain ignores the lazy eye, the cells in the brain that create vision do not develop properly. Generally, Amblyopia affects just one eye but sometimes both eyes can have a problem.

What causes a ‘lazy eye’?

For children, the most important period for the development of vision is from birth to the age of 6 and if there is any interference with development during this period, then this can lead to amblyopia which is commonly caused by a squint (strabismus) in one eye, anisometropia (different vision/prescriptions in each eye), and/ or obstruction of an eye due to cataract, trauma, lid droop, etc.

Why does my child need to wear a patch?

The best and simplest way to treat lazy eye is to cover or patch (known as occluding) the other eye so the vision in the lazy eye can improve and develop the pathways to the brain.
The patch is worn over the good eye and the amount of time the patch must be worn is decided by the Orthoptist/Ophthalmologist and relates to the extent of the visual problem.
With early treatment by patching, vision can develop successfully but this becomes more difficult with older children and the level of vision achieved may not be as good.

My Child’s Treatment

Patient name:
Patient number:
Glasses must be worn
Please patch the eye RIGHT LEFT
For hours a day.
If the child wears glasses, he or she should continue to wear them even with the patch.