Cornea Transplant

If your cornea becomes cloudy, scarred or diseased, a cornea transplant could 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.

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What is a corneal transplant?

A corneal transplant is a surgical procedure that replaces all or part of your damaged cornea with donor corneal tissue. Corneal transplants can be categorized as “full thickness” or “back layer.” The goal is to replace damaged or diseased cornea tissue that is impacting the patient’s vision beyond what can be corrected with eyeglasses or contact lenses.

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.

What To Expect During a Cornea Transplant

Cornea Transplant Surgery Albany NY

Dr. Schultze teaching his fellow cornea transplant surgery

During the corneal transplant surgery, Dr. Schultze or  Dr. 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.

Post Cornea transplant

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 to 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.

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What are the Alternatives to a Corneal Transplant?Cornea Transplant Slingerlands NY

Phototherapeutic Keratectomy (PTK)

Phototherapeutic keratectomy (PTK) is one of the latest advances in eye care. It allows patients with corneal dystrophies, corneal scars, and certain corneal infections to avoid a corneal transplant.

These procedures combine the precision of the excimer laser (the same laser used in LASIK procedures) with the control of a computer, allowing Dr. Schultze or Dr. Eden to vaporize microscopically thin layers of diseased corneal tissue and etch away the surface irregularities associated with various corneal dystrophies and scarring. PTK surgery removes the epithelium, along with some of the underlying corneal stroma. This new procedure allows the patient to keep his or her cornea, and new tissue will grow over the surface that has been smoothed.

The primary goal of a PTK is to produce a smoother and clearer cornea. You may still need to wear glasses to attain your best vision, but PTK should make dramatic improvement.

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.

Benefits of an Endothelial Keratoplasty

Cornea Transplant Slingerlands NY

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.

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Descemet Membrane Endothelial Keratoplasty (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 are only 15 to 20 microns thick.

What to expect during DMEK procedure

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 the chance of rejection.

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Additional FAQs

Who would be a candidate for a corneal transplant?

Corneal eye disease is the fourth most common cause of blindness. It affects over 10 million people worldwide. If your cornea is damaged due to disease or injury, it can become swollen, scarred, or severely misshapen and this distorts your vision. A cornea transplant could be necessary if eyeglasses or contact lenses can no longer correct the vision enough to be functional. Sometimes, painful swelling can also dictate a transplant.

These are some conditions that can be treated with a cornea transplant:

  • An outwardly bulging cornea
  • Fuch’s dystrophy
  • A thinning cornea
  • Clouding of the cornea
  • Cornea scarring from injury or infection
  • Swelling of the cornea
  • Corneal ulcers
  • Complications from previous eye surgery

What are the benefits of corneal transplant surgery?

These surgeries with Dr. Schultze or Dr. Eden are very successful. Overall, around 90 percent of corneal transplants have successful integration of the corneal graft. For our Cornea Consultants patients, these procedures can restore the patient’s vision, reduce pain, and improve the appearance of the damaged or diseased cornea. The new cornea should perform for about a decade or longer. Plus, once the graft is integrated and your healing is complete our surgeons can further improve the quality of your vision by adjusting the tension of some of your stitches. Refractive errors can also be corrected with the normal methods of eyeglasses, contacts, or for some patients, laser eye surgery.

Is corneal surgery painful?

There isn’t any pain with your surgery and recovery. You simply need to be patient, as full visual recovery can take up to a year. You need to be quite diligent with your steroid eye drops, as these will help ensure your body doesn’t reject your grafted corneal tissue.

What are the advantages of phototherapeutic keratectomy versus a corneal transplant?

The big advantage is that the patient keeps their cornea, rather than needing grafted corneal tissue. This eliminates the possibility of the body rejecting the donor tissue. Although the success rates with PTK are slightly lower than a corneal transplant, at 85 percent versus 90 percent, the recovery is much faster, usually just a matter of days, compared to months with a transplant. Vision returns rapidly, especially if only the top layer of the cornea was affected.

Is phototherapeutic keratectomy surgery painful?

These are not painful procedures. Obviously, you’ll not feel anything during the procedure, and recovery is not difficult. After PTK, the eye can be sore, feel scratchy, or be prone to excessive tearing for several days. A bandage contact lens is placed at the time of surgery to reduce postoperative discomfort. You’ll wear this contact lens for several weeks, possibly months, to allow your eye to fully heal.

Who is a candidate for phototherapeutic keratectomy?

The best candidates for PTK have opacities in the outer 10-20 percent of the cornea, without significant irregularity and thinning. If the patient has both superficial and deep stromal lesions, only the superficial lesions can be usually treated with PTK. The PTK procedure is useful for people with inherited disorders, whose scars or other corneal opacities limit vision by blocking the way images form on the retina.

How long does a phototherapeutic keratectomy procedure take?

As with many laser eye procedures, these are incredibly fast surgeries. The entire treatment typically lasts less than 15 minutes.

 

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