Cornea Transplant an Option for Eyesight, but PPP a Safer Alternative: Dr. Agarwal

Chennai (RNI) Renowned ophthalmologist Dr. Amar Agarwal has stated that while corneal transplant remains an option for millions of patients who have lost their eyesight, the surgery is risky. As an alternative, he recommended a newer technique — Pinhole Pupilloplasty (PPP).

In an exclusive interview, Dr. Agarwal explained that PPP is a surgical technique in which the pupil is reshaped into a small, centralized opening using sutures, significantly improving vision in patients with irregular corneas.

Dr. Agarwal, Chairman of Dr. Agarwal’s Eye Hospital Group, said that corneal transplants come with multiple challenges: surgical risks, the need for long-term immune suppression, and an increasing shortage of donor corneas.

To address these challenges, Dr. Agarwal has introduced Pinhole Pupilloplasty in India — a minimally invasive, highly effective alternative that has already been adopted in countries like Russia, Vietnam, and Egypt.

He emphasized that the global shortage of donor corneas has left millions visually impaired or blind. In such cases, PPP presents a safe and practical solution.

The technique can significantly enhance the vision of patients with corneal irregularities caused by conditions such as keratoconus, scarring, or higher-order aberrations, often eliminating the need for glasses or contact lenses.

Describing the procedure, Dr. Agarwal said it involves creating a small, custom-sized pinhole in the iris to filter incoming light. This pinhole blocks peripheral distorted rays and allows only focused light to reach the retina, resulting in clearer vision for those with irregular corneas.

Compared to traditional corneal transplant surgery — which is complex, requires a long recovery period, and carries a risk of rejection — PPP is simple, fast-healing, and low-risk.

“The biggest strength of Pinhole Pupilloplasty lies in its simplicity,” he added. “It doesn’t require expensive equipment or donor tissue and can be performed using standard ophthalmic surgical tools, making it accessible even in resource-limited areas.”

This adaptability has led to rapid adoption of the technique by eye care centers globally, helping address corneal blindness at the local level.

Dr. Agarwal noted that over 20 million people worldwide suffer from visual impairment or blindness due to corneal conditions, and most of them will never receive a donor cornea. With corneal blindness cases on the rise, PPP offers a viable alternative.

Notably, the procedure has already been implemented in over 250 hospitals within the Dr. Agarwal’s Eye Hospital network, both in India and abroad. The group recently launched its first hospital in New Delhi, headed by Dr. J.S. Titiyal, former head of the ophthalmology department at AIIMS.

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