Types of Corneal Transplants

Types of Corneal Transplants

Atlanta Cornea Transplant Specialists

The cornea is a very unique surface structure that focuses light and protects the internal structures of your eye. A clear and healthy cornea is necessary for clear vision. If the cornea becomes diseased, it can be partially or completely replaced by a corneal transplant procedure. Your corneal expert at Eye Consultants of Atlanta will guide you to the best option for you.

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Traditional Cornea Transplant

A traditional corneal transplant, also known as a corneal graft, or as a penetrating keratoplasty, involves the removal of the central portion (called a button) of the diseased cornea and replacing it with a donor button of cornea. Corneal grafts are performed on patients with damaged or scarred corneas that prevent acceptable vision. This may be due to corneal scarring from disease or trauma. The diseased tissue is removed and a donor tissue sewn in place. This is the most extensive form of transplant and requires significant post op care.

The healing process following this type of corneal transplant is long, often taking on average a year. Removal of the corneal sutures can occur as early as 6 months after surgery but can be up to a year or longer after surgery.The patient may be on steroids for many months after the surgery. in 11% to 18% of the patients. Symptoms of corneal rejection include eye redness, blurred vision, pain, and light sensitivity. Inform your doctor if any of these symptoms develop, as timely and treatment can stop the rejection process

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DALK – Deep Anterior Lamellar Keratoplasty

Deep Anterior Lamellar Keratoplasty (DALK) is a newer method of cornea transplant for anterior corneal disease such as keratoconus, corneal scars and stromal dystrophies. Only the diseased anterior layers of the cornea are replaced and the innermost layer of the patient’s cornea, the endothelium, is retained. Because the inner layer is retained, there is less risk of rejection and the corticosteroid medications can be discontinued sooner than with a penetrating keratoplasty.DALK can have a lower risk of astigmatism and its longevity may be longer than a standard full- thickness transplant.

Anterior Corneal Transplant (DALK) Advantages

Maintaining an intact inner layer, or endothelium, reduces several of the major challenges and vulnerabilities associated with corneal transplantation. Theoretically, DALK leaves the patient with a stronger wound because a strong deep layer of the cornea, called Descemet’s membrane, remains intact.

DSEK and DMEK

DSEK stands for Descemet’s Stripping Endothelial Keratoplasty. This surgery is a type of Endothelial Keratoplasty where only the inner layers of the cornea are replaced. This surgery is commonly performed for corneal conditions affecting the innermost layer of the cornea, the endothelium. Two of the most common conditions for DSEK are Fuchs Endothelial Corneal Dystrophy and Bullous Keratopathy. In Fuchs Dystrophy, the cells of the endothelium are swollen and do not pump fluid out of the cornea as they should. Patients complain of blurry vision, fluctuating vision worse in the morning, glare and halos around lights and a rough or gritty feeling in the eyes. Patients with Bullous Keratopathy may have similar symptoms and may have undergone a recent intraocular surgery like cataract surgery or have had an infection in the cornea. Your ophthalmologist and cornea specialist can help distinguish if you have one of these conditions.

Advances in ophthalmic surgery have allowed cornea surgeons to perform DSEK surgery which replaces the unhealthy Descemet’s layer and endothelium with only the posterior stroma, Descemet’s Membrane and the Endothelium instead of an entire cornea. The surgery is faster, less invasive and has a quicker post op visual recovery timeline than a penetrating keratoplasty. Patients may have to lie flat for a day after the surgery because an air bubble is placed safely inside the eye to allow the new corneal cells to settle in place.

DMEK surgery is a newer version of an endothelial transplant where only Descemet’s membrane and endothelium are needed to replace your dysfunctional corneal tissue. It is less invasive even than DSEK and has more potential for clearer vision after surgery. The post operative healing time is about a week longer than DSEK because often the gas or air bubble your surgeon places inside the eye lasts for a longer time.
These two cutting edge procedures allow your surgeon to transplant only the diseased inner layer of the cornea. The cornea surgeons at Eye Consultants of Atlanta have performed thousands of these cases. This type of transplant has the lowest risk of rejection, astigmatism, and other important complications.

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(404) 351-2220