Corneal & External Eye Disease

What We Do

The Corneal & External Eye Disease Department is led by Associate Professor Marcus Ang (Head and Senior Consultant) and comprises 10 fellowship-trained cornea subspecialists, providing medical and surgical care for patients with corneal disorders.

The department offers a wide range of transplantation services including all forms of penetrating and lamellar corneal transplants, ocular surface stem cell reconstruction, and transplantation of artificial corneas such as the osteo-odonto-keratoprosthesis (OOKP), and Boston keratoprosthesis). 

Our medical expertise include the diagnosis and management of cornea ectasias and dystrophies,  infectious keratitis, contact lens problems, ocular surface disorders and dry eyes, supported by a comprehensive suite of imaging services. Additionally, the department has one of the few medical contact lens services available in the region. A wide range of contact lenses are available – ranging from specialty corneal gas permeable lenses to scleral lenses – to manage a range of conditions including keratoconus, aphakia, high myopia with high astigmatism, cornea scars and irregularities.

A number of different transplant procedures, including penetrating keratoplasty (PK), anterior lamellar keratoplasty (ALK), and endothelial keratoplasty (EK), have been introduced at Singapore National Eye Centre (SNEC) over the years. The SNEC and Singapore Eye Bank (SEB) work hand-in-hand to maintain the high quality and exacting standards needed for cornea transplantation.

Key facts and figures

• The SNEC Cornea Transplant Programme began in 1991, and SEB was set up in 1993.

  80% of corneal transplants in Singapore are performed at SNEC.

• The department has a cornea transplant survival rate of more than 90% in the first year for optical transplants, comparable to the top transplant centres in the world.

• SNEC is the regional referral centre for complex corneal procedures. Descemet-stripping automated endothelial keratoplasty (DSAEK) surgeries account for more than 50% of the corneal transplants performed here, and lamellar keratoplasty accounts for 75% to 80% of all transplants.

• The department is an international teaching centre for complex corneal transplants and other complex surgeries (e.g. OOKP).

  
  

Breakthroughs in technology and future developments

1. Osteo-Odonto-Keratoprosthesis (Tan et al., 2008)
   This landmark “tooth-in-eye” surgery, first performed in Singapore in 2004, is a complex procedure for those who have lost their vision due to corneal or ocular surface disorders and who are not suitable for conventional corneal or stem cell transplant treatment regimens. SNEC has successfully restored the vision of more than 50 patients, nationally and internationally, using this procedure.

   
   

2. The EndoGlide for EK surgery
   A surgical device, the EndoGlide, was invented in 2009 by Professor Donald Tan and Associate Professor Mehta for DSAEK. This device enables endothelial keratoplasty through a small incision in the patients’ eye, with ease and minimal tissue trauma. It was first used as part of the SNEC DSAEK EndoGlide Clinical Trial, and about 600 eyes have undergone DSAEK surgery using the EndoGlide in SNEC.  This device has been shown in the published literature to have a low rate of endothelial cell loss and a reduced risk of complications). Approximately 20,000 corneal transplants have been performed to-date with this device.
   SNEC and the Singapore Eye Research Institute (SERI) have also patented a new surgical device, similar to the EndoGlide, for use in Descemet membrane endothelial keratoplasty (DMEK).

   
   

3. ALK techniques for corneal transplant
   The Advanced Lamellar Keratoplasty/DSAEK training course was initiated in 2006 and is directed by Professor Tan and Associate Professor Mehta.  Annually, 14 to 16 surgeons from within and outside the Asia-Pacific region are trained in an intensive 3-day course, with hands-on wetlab experience and a live demonstration of the latest lamellar surgery techniques. Our faculty also conducts condensed versions of this advanced lamellar course internationally, in countries such as the United States, Europe, Korea, India and China.

   
   

4. Ocular Stem Cell Transplant Service
   An Ocular Stem Cell Transplant Service was introduced in 2003.

   
   

5. Future aspirations of the Corneal and External Eye Disease Department
   The future aspirations of this department are to:
   a. carry out trials with endothelial cell culture/ tissue engineered transplants
   b. introduce the use of femtosecond lasers for ocular surface reconstruction
   c. evaluate a new artificial cornea to replace the existing implants for OOKP.