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Corneal transplantation including endothelial transplantation

Corneal TransplantWhat is a corneal transplant? Is it safe?

A corneal transplant involves replacing a diseased or scarred cornea with a new one. When the cornea becomes cloudy, light cannot penetrate the eye to reach the light-sensitive retina. Poor vision or blindness may result.In traditional corneal transplant surgery, the surgeon removes the central portion of the cloudy cornea and replaces it with a clear cornea, donated through an eye bank. A trephine, an instrument like a cookie cutter, is used to remove the cloudy cornea. The surgeon places the new cornea in the opening and sews it with a very fine thread. The thread stays in for months or even years until the eye heals properly (removing the thread is quite simple and can easily be done in an ophthalmologist's office). Following surgery, eye drops to help promote healing will be needed for several months.

Corneal transplants are very common in the United States; about 40,000 are performed each year. The chances of success of this operation have risen dramatically because of technological advances, such as less irritating sutures, or threads, which are often finer than a human hair; and the surgical microscope. Corneal transplantation has restored sight to many, who a generation ago would have been blinded permanently by corneal injury, infection, or inherited corneal disease or degeneration.

What problems can develop from a corneal transplant?

Problems From Corneal TranplantEven with a fairly high success rate, some problems can develop, such as rejection of the new cornea. Warning signs for rejection are decreased vision, increased redness of the eye, increased pain, and increased sensitivity to light. If any of these last for more than six hours, you should immediately call your ophthalmologist. Rejection can be successfully treated if medication is administered at the first sign of symptoms.

If you experience any such problems after surgery, please contact us, as we always have someone on call to examine you or can arrange for you to be seen locally.

Newer developments in cornea transplant

More recent developments in corneal transplant allow safer surgery for patients with faster healing and more stable long-term results. They have their own unique advantages and disadvantages, but our doctors can tell you if you are a candidate.

Endothelial Transplant

Modern History of Endothelial Transplant

In 1998, Dutch ophthalmologist Gerrit Melles, MD described a technique in which the inside layers of the cornea were manually dissected and selectively replaced (Melles et al, 1998). In 2001, Mark Terry, MD described a modified technique in which the dissection was performed with viscoelastic and termed his technique deep lamellar endothelial keratoplasty, or DLEK (Terry & Ousley 2001). The manual dissection is tedious and involves a steep learning curve. Dr. Melles has since developed a technique that involves stripping of Descemet’s membrane instead of a lamellar dissection, which has been termed Descemet’s stripping endothelial keratoplasty, or DSEK (Melles et al, 2004).

Advantages of Endothelial Transplant

Endothelial transplantation offers several advantages including less postoperative astigmatism, faster visual recovery, and stronger wound integrity (Terry & Ousley 2001). Theoretically, there is less risk of rejection since less of the patient’s tissue is replaced. Finally, there is the potential to make more efficient use of transplant tissue—using the endothelium for DLEK, DSEK, or DSAEK in one patient and the stroma for a lamellar graft in another. It is useful in patients with varying types of endothelial dysfunction, including Fuchs Dystrophy, Pseudophakic Bullous Keratopathy (PBK), Aphakic Bullous Keratopathy (ABK), and Posterior Polymorphous Dystrophy (PPMD) (Melles et al, 1998, Terry & Ousley 2001).

Technique of Endothelial Transplant

Dr. Rosenwasser is experienced in both DLEK, DSEK, DSAEK, and DMEK corneal transplants as well as the DALK procedure for keratoconus. Dr. Rosenwasser has done over 600 endothelial keratoplasties by the Fall of 2009.

Watch a video of this procedure.

Deep Anterior Lamellar Keratoplasty

Deep anterior lamellar keratoplasty is a technique in which the front 95% of the cornea is removed, allowing patients to keep their own endothelium.

The surgery offers more safety and stability to patients during surgery. It also reduces the risk of rejection and transplant failure.

This technique takes longer to perform than a traditional transplant. It may be a good option for certain patients, for example, those with keratoconus or corneal scarring.