Cornea Surgery

Corneal transplant surgery has been a very successful option for people with corneal scars or other problems that cause the loss of transparency of the cornea. It requires a central circular excision of tissue and replacement with donor tissue. Sutures have been the standard for years which result in astigmatism. While this is successful, most of the time the process requires 6 months to a full year for visual rehabilitation and glasses or contact lens correction is typically needed for good vision. Recently and presently newer techniques are developing which correct both anterior and posterior problems of the cornea with either no sutures or minimal sutures. The healthy part of the cornea is left and only the front or back is replaced, which results in faster healing and less risk during the procedure.

(DSEK/DSAEK) Descements Stripping Endtheal Keratoplasty

DESCEMENTS STRIPPING ENDOTHELIAL KERATOPLASY (DSEK/DSAEK) is a suture-less, partial thickness transplant technique for the posterior cornea that is revolutionizing corneal transplant for Fuchs Dystrophy. This exciting new surgery has been developing in popularity over the past decade and in August of 2006 Dr. Mellgren began performing this surgery and it has been a total blessing. It is replacement of the inner two layers of the cornea instead of a full thickness corneal transplant. This surgery best suits people with FUCHS CORNEAL DYSTROPHY and anyone who has had prior eye surgery with resulting corneal swelling. It is not good for people with anterior corneal pathology. (Anterior lamellar corneal transplant is the promising treatment for anterior defects.)

The post op recovery depends on the amount of corneal swelling present at the time of surgery and on the health of the donor tissue as well as its handling during surgery. Some of the patients can see 20/40 (which is driving vision) in just two months while in other cases that may take about 6-8 months. Either way that is much faster rehabilitation than with traditional full thickness corneal transplant. Another added benefit is that the cornea retains it normal shape and there will be less astigmatism post operatively compared to traditional surgery.

More About DSEK

Historically, full-thickness corneal transplant surgery has not changed significantly in the last 30 years. A conventional corneal transplant requires long periods of convalescence, sometimes upwards of 12 months for patients to enjoy good-stable vision. The traditional corneal transplant procedure requires multiple sutures and a lengthy post-operative recovery period until one reaches their final refraction and "best-spectacle-corrected vision". Now, with the advent of DSEK, we are able to make a small 1/4 inch incision in the eye and insert a partial thickness corneal transplant which requires only a single suture and several weeks for good recovery of vision.

DSEK is specifically suited for patients who have posterior corneal diseases with endothelial dysfunction. Patients with corneal conditions such as Fuch's dystrophy, bullous keratopathy or failed prior corneal transplants are surgical candidates who may benefit from the DSEK technique.

Fuch's Corneal Dystrophy

Fuch’s Corneal Dystrophy is a genetic condition that is found in about 4% of the population. A person is usually asymptomatic until middle age or later. Some early symptoms may include photophbia or increased glare. Later the corneal can swell or fill up with too much fluid causing both decreased vision and discomfort. The inside layer of cells in the corneal called ENDOTHELIUM are responsible to keeping the cornea in a dehydrated state. In Fuch’s Dystrophy these endothelial cells do not function as well as they should, and signs of this can be detected on eye examination.  When endothelial cells become too weak or too few to do their job, the corneal collects too much fluid becoming thicker and starts to turn white or bluish. Visual symptoms are decreased vision, hazy vision like looking through a fog, halos around lights at night, decreased reading vision and blurry vision on awakening that improves as the day goes on. If the swelling is severe the vision can be bad enough to prevent driving and reading. Fortunately there are wonderful techniques like Endothelial Keratoplasty (DSAEK/DSEK/PLK) that can restore vision in people with Fuch’s Dystrophy.

Benefits of DSEK

• Stronger corneal integrity with less sutures
• Faster recovery and rehabilitation
• Reduced chance of corneal graft rejection
• Much improved vision: several weeks rather than several months

If you think you may benefit from this procedure or know someone who may need a corneal transplant, please schedule a consultation today by calling 1-800-738-8816.

Corneal Facts

The Corneal is the clear portion at the front of the eye, and is the first thing that light is refracted off of and therefore the most important refracting component of the eye. It happens to be a very tough and unique tissue. It has no blood vessels and is optically clear. It heals differently than most of the body. The surface cells rapidly divide and replenish themselves correcting quickly for corneal abrasions or damage. The inner layer of the cornea, called endothelium, does not divide or replenish itself. The main body of the cornea called stroma, varies in thickness and is mainly composed of nerves and collagen support tissue. It can heal and replenish itself, but does so slowly.