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Corneal Transplant procedures

Corneal Transplants or Penetrating Keratoplasty

The cornea is a clear tissue on the surface of the eye that covers the iris (colored part of the eye).  Any disease or injury that results in clouding of the cornea or loss of corneal tissue may be an indication for corneal transplantation as a means to restore clear vision to the patient.  The most common infectious cause of a damaged cornea necessitating corneal transplant is herpes simplex keratitis.  Other patients may have inherited corneal diseases such as keratoconus and Fuchs’ dystrophy, which interfere with the functioning of the cornea.  Scars from injury are other reasons for surgery.
When Necessary? Cornea1 The surgery involves removal of the patient’s damaged cornea in the operating room under local or general anesthetic with a trephine (a circular blade some compare to a ‘cookie cutter’).  See diagrams.  If other procedures need to be done such as cataract extraction or intraocular lens exchange, these are done before placing the new, (donor), cornea on the patient’s eye.  The donated corneal tissue is cut into a circular shape usually slightly larger than the opening left when the patient’s damaged cornea is removed.  It is then sewn into place on the eye with very small nylon sutures.  The surface layer (or epithelium) of the cornea will heal over the sutures so the patient doesn’t feel them after a few days to weeks.   It can take an average of one year for a corneal transplant to completely heal and reach the final vision (depending upon condition of eye and the age of patient).  Of course, to achieve excellent postoperative vision, the rest of the eye needs to be healthy and functioning well.  This means that other ocular diseases such as glaucoma, cataract, retinal detachment, or macular degeneration need to be recognized and treated (if possible).
1. White arrow shows opaque, damaged cornea. 2. Round shaped portion of damaged cornea removed. 3. A donor button of clear cornea is replaced. 4. The donor cornea is sutured into place.
The Results
Cornea2
Dr. Kent has over 17 years experience performing this surgery and very high success rates of improving vision.  She works closely with the patient before and after the surgery to be sure the patient is prepared and understands how to care for the eye postoperatively.  This is not a surgery to be undertaken lightly and the doctor-patient relationship is very important for a successful outcome.  Dr. Kent enjoys working closely with her patients and strives to make each patient feel cared for and satisfied with his/her results.

DSAEK

 (Descemet’s Stripping Automated Endothelial Keratoplasty)

Your Eye

Your cornea is an amazing structure of tissues.  It is composed primarily of three layers, the outer layer is called the epithelium, the middle or stromal layer, and the inner layer which is called the endothelium.  The cornea is a dime-sized piece of clear tissue that allows light to pass through like a window.  The light then passes through the lens of the eye and on to the retina where an image is formed.  Special retinal cells send nerve impulses to the brain via the optic nerve.  In order to have good vision, all parts of the eye must work together.  When one or more parts fail, vision can start to fail.

Just like a foggy window, where light has difficulty passing through, a foggy cornea can cause blurred images.  In certain conditions caused by either trauma or degenerative processes (Fuch’s Dystrophy), the cornea can become cloudy due to scarring or swelling.  In patients with Fuch’s Dystrophy , the endothelial layer which is comprised of cells who’s job it is to pump fluid out of the cornea, fail and the endothelial layer becomes swollen and cloudy.  A cornea transplant was the only option, where the center part of the cornea was removed in its full-thickness and replaced with a donor cornea.  Sutures are placed until the cornea heals which can take up to one year.

DSAEK

With the advancement of Ophthalmology, a new procedure has been developed called a DSAEK.  It is a partial thickness corneal transplant where the endothelial layer is surgically removed from the stroma and replaced by donor endothelial tissue. An air bubble is used to hold the tissue in place and healing time is greatly decreased. 

What Next

Patients will receive a complete evaluation using state-of-the-art equipment at Colorado Corneal Surgeons so that Dr. Holly Kent can best determine the patient’s treatment and/or surgical options.  Dr. Kent works closely with Rocky Mountain Lions Eye Bank to ensure the best possible tissue.

On the day of surgery, the patient will arrive approximately 1 ½ hours prior to surgery for preparation.  The patient must not eat or drink anything eight hours prior to surgery.  Surgery typically lasts about an hour.  The patient must lie flat on their back so the air bubble can push up onto the new tissue and hold it in place.  After the tissue has a chance to stick and stay in place it will begin to pump water out of the cornea and the cornea will then start to clear.  The patient will return to Dr. Kent the next day after surgery and will continue to be closely monitored at regular intervals.

As with any surgical procedure, there are risks associated with the benefits which will be discussed in detail with the surgeon prior to any decisions being made.  Please feel free to contact our office with any questions.  We would be happy to speak with you. 

303-777-5006

Comparison between DSAEK and Corneal Transplant

Cornea Transplant
DSAEK 

Approximate time

for vision improvement 

6-12 months 2-4 months
Time of surgery   45-60 mins   60 mins
Sutures  16 0
Contact lens required Rigid gas permeable Usually no contact lens required
Diagnosis for surgery  Keratoconus, Corneal scar, Corneal ulcer Fuch’s dystrophy, corneal edema, Bullous keratopathy

 

Helpful Links

Endothelial Keratoplasty

www.dlek-dsek.com

Corneal Dystrophy Foundation

www.cornealdystrophyfoundation.org

Fuchs Friends

www.fuchs-dystrophy.org

Rocky Mountain Lions Eye Bank

www.corneas.org

IntraLase Enabled Keratoplasty

IEK

IntraLase™ enabled keratoplasty gives surgeons the ability to precisely create uniquely shaped corneal incisions — opening a new era in corneal transplantation and delivering the potential for faster healing and improved visual recovery. Leading corneal surgeons have demonstrated that this technology advancement enables:

  • Surgeons to create straight, angled and arcuate incisions within the cornea
  • Multiplanar custom incisions with hermetic sealing properties that require less suture tension
    • Less suture tension can result in less astigmatism1
    • Multiplanar custom incisions provide larger wound surface area for stronger healing
  • Laser resectioning that produces more rapid healing1
  • Earlier suture removal and rapid visual rehabilitation1

Create Customized Incisions With Advanced Edge Profiles

Mushroom incision profile

Top-hat incision profile

Zig-zag incision profile

The mushroom-shaped incision preserves more host endothelium than the traditional trephine approach.1

The top-hat-shaped incision allows for the transplantation of large endothelial surfaces.1

The zig-zag-shaped incision provides a smooth transition between host and donor tissue and allows for a hermetic wound seal.1


Establish Secure Grafts, Requiring Less Suture Tension1

1 week after surgery

3 months after surgery

6 months after surgery

1 week after surgery

3 months after surgery

6 months after surgery

Early experience indicates that IEK incisions create less irritation, form hermetic wound seals, and produce crystal-clear corneas at 1, 3, and 6 months. In addition, all sutures were removed before 6 months vs. 1 year with standard trephine techniques.2

Reduce the Incidence of Induced Astigmatism

Zig-zag incision

IEK 3 months
after surgery

Trephine 1 year
after surgery

Zig-zag incision

IEK 3 months after surgery

Trephine 1 year after surgery

The zig-zag-shaped incision has shown a smooth corneal contour immediately after surgery, with less distortion of the corneal optics and less astigmatism.1

IEK result at 3 months after surgery = 0.5 diopter of astigmatism.1

Typical result with standard trephine-cut PKP at 1 year after surgery = 8 diopters.1

  1. Steinert RF. Femtosecond laser corneal surgery. Data presented at: American Academy of Ophthalmology, November 11-13, 2006; Las Vegas, NV.
  2. Photos and personal communication, Francis W Price, Jr, MD.

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