Overview of Corneal Transplant
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. The corneas are usually donated from an eye bank for this procedure, and eye drops are needed after the surgery.
When possible, the eye care specialists on the medical staff at Baylor Scott & White Health will do a partial replacement of the cornea such as an endothelial keratoplasty or anterior lamellar keratoplasty. These newer surgeries are usually safer and result in quicker return of vision. However, many conditions are still best managed with a full thickness corneal transplant called a penetrating keratoplasty.
Corneal Transplant Surgeries
Descemet Membrane Endothelial Keratoplasty (DMEK)
This is the newest type of corneal transplantation that is only being done at a limited number of locations. During this procedure, Dr. Aaker will remove the cells in the back of the cornea and replace them with the identical tissue from the donor (1/100th of a millimeter thick) which is attached with an air bubble. The front of the cornea is left unchanged except for a small incision. This surgery usually only requires one stitch compared to sixteen or more for a typical cornea transplant. Vision returns much quicker after this surgery and there often is complete visual rehabilitation by four weeks. The highest percentage of patients are corrected to 20/20 after this surgery compared to other types of corneal transplants. This is usually the preferred transplant for Fuchs dystrophy.
Descemet Stripping Endothelial Keratoplasty (DSEK)
During this procedure the cells in the back of the cornea are removed and replaced with a thin piece of cornea tissue which is attached with an air bubble. It is similar to DMEK, but utilizes a thicker piece of tissue. Some people are not a candidate for DMEK, but are still a good candidate for this surgery. It usually requires three stitches and vision may be finalized as soon as six weeks. This is usually preferred for bullous keratopathy and sometimes for Fuchs dystrophy.
Anterior lamellar keratoplasty
In this partial replacement procedure only the front part of the cornea is removed and replaced with the front of another cornea. It is attached with a very fine thread which may be left in place for months or even years. This type of surgery decreases the risk of rejection, damage from trauma, and risk of the surgery. This surgery is often used for keratoconus, and corneal scars.
This surgery removes the full thickness of the central cornea and can be used when there is damage to all layers of the cornea. It also uses a very fine thread that may be left in place for months or even years. This is also often used for infections, and other conditions with severe damage.