If your cornea becomes cloudy, scarred or diseased, a cornea transplant may be your best option to save your sight. The cornea is a very important part of the eye, and, if left damaged, patients can suffer vision loss or blindness.
During the corneal transplant surgery, Drs. Schultze or Eden will remove an eight-millimeter central portion of the cloudy or damaged cornea and replace it with a new, clear one. Your new cornea will often come from an eye bank after being screened for suitability and infectious diseases. Your surgeon will place the brand new cornea in the opening left from removing the old cornea and secure it in place with a very fine suture. These tiny sutures will remain in your eye for a few months while the eye heals, and then will be removed easily and gradually during visits to our office.
Your surgeon will prescribe you eye drops to use after surgery to help your eye heal and to prevent infection. Your vision will be blurry at first due to stitches and post-operative swelling, but most people are able to return to work and daily life about a week after surgery. Full visual recovery can take up to a year, and it is vital that patients take their medication as directed, keep follow-up appointments and pay close attention for any increased redness, discharge, sensitivity to light, pain or blurring. This can be an indication of transplant rejection and should be reported to our office immediately so that we may be able to reverse the condition.
Corneal transplants are very common in the United States; about 40,000 are performed each year. While success rates may vary due to pre-existing conditions in your eye, technological advancements have increased your chance of success. Approximately 90% of corneal transplants are successful, and the new cornea will stay healthy for an average of 10 years. In the unlikely event that your surgery is not successful, or if your cornea does become cloudy again, you can always receive another transplant.
Alternatives to a Corneal Transplant
Phototherapeutic Keratectomy (PTK)
Until very recently, if you had corneal dystrophies, scarring, or certain infections, your only option was a corneal transplant. However, with advancements in eye care and treatment, a new procedure called phototherapeutic keratectomy (PTK) is now an option. By combining the precision of the excimer laser – a laser that uses UV light to remove irregularities in the corneal tissue – with the control of a computer, doctors can vaporize microscopically thin layers of diseased corneal tissue and etch away the surface irregularities associated with many corneal dystrophies and scars. With this approach, the surrounding areas suffer relatively little trauma. New corneal tissue will then grow over the now-smooth surface to fully repair the cornea. You will recover from PTK in a matter of days, rather than the month-long recovery of a transplant. Your vision will return rapidly, especially if it is just the top layer of your cornea that was affected. PTK has been shown to have an almost 85% success rate in repairing the cornea.
EK (Endothelial Keratoplasty)
Endothelial Keratoplasty (EK), also known as Descemet Stripping Automated Endothelial Keratoplasty (DSAEK), is a newer method of corneal transplantation and only involves replacing some of the posterior or inner layers of the cornea, instead of its full thickness as in standard corneal transplantation. For this reason, if your disease affects the full thickness of the cornea, you are not a candidate for EK.
Cornea Consultants of Albany doctors have been pioneers in the field of endothelial keratoplasty. They were the first surgeons to perform the procedure in the state of New York in 2003 and have been extremely successful. Drs. Schultze and Eden are the recognized leaders in Northeastern New York in advanced techniques of corneal transplant surgery and are acknowledged around the world for their research and achievements.
While EK is a relatively new surgery, and therefore hasn’t been studied as thoroughly as the standard procedure, there are many advantages. Compared to the standard transplant procedure, your surgeon can make a smaller incision in the eye so fewer stitches are needed. Your recovery is drastically shortened with the eye healing in 3-6 months, as opposed to a year. Your eye will have less chance of injury during surgery, and with fewer stitches there is less chance of infection.
Descemet Membrane Endothelial Kertoplasty (DMEK)
A Descemet membrane endothelial keratoplasty (DMEK) is very similar to DSAEK, except that the implanted donor tissue does not include any stromal tissue. A DMEK is an exciting option to treat decreased vision and swollen cloud corneas and it is a pure replacement of endothelium. There are three generations in the evolution of corneal transplantation and DMEK is the third and newest, but the surgeons of Cornea Consultants of Albany have been performing this surgery for three years and were some of the first in the Northeast to do so. DMEK is the most anatomical repair of the three generations of corneal transplantation with just one cell layer and a thin membrane, all of which is only 15 to 20 microns thick.
During DMEK surgery, the diseased innermost layer of the cornea is removed and the thin layer from a healthy donor cornea is put in its place. The transplant is then held in place by only an air bubble. Patients will be required to lay flat on their backs with their faces directed upwards immediately after surgery to float the bubble into place. DMEK has been shown to offer patients the best chance to see 20/25 and resume their daily activities quickly.
Deep Anterior Lamellar Keratoplasty (DALK)
Deep Anterior Lamellar Keratoplasty (DALK) is an additional newer method of corneal transplantation. It only replaces the superficial layers of the cornea, so there is less risk of damage to the eye. You are a good candidate if you have a disease that only affects the outermost layers of the cornea, like keratoconus. Because this procedure is extremely technical, the success rate is approximately 75%. Fortunately, if the cornea does not divide optimally at the time of the procedure, a full-thickness keratoplasty remains an option to rehabilitate vision. The advantages to DALK include greater structural integrity of the eye and decreased chance of rejection.