Cornea Transplants May Vastly Improve Your Vision
The cornea is the clear window of the front of the eye that covers the color iris and the round pupil.  The cornea focuses light onto the retina, which is at the back of the eye.  If the cornea becomes damaged or diseased, the resulting scars and swelling may cause cloudy and distorted vision.  A corneal transplant may be needed if vision cannot be corrected or if painful swelling cannot be relieved.  A corneal transplant replaces the damaged cornea with a healthy, clear cornea.  Transplants may be full thickness (PKP- Penetrating Keratoplasty) or partial thickness (DSAEK - Descemet's Stripping with Assisted Endothelial Keratoplasty).

New Cornea Transplant Technique Allows for Quicker Recovery

Dr. Murray Friedberg, a fellowship-trained cornea specialist, now offers a new surgical procedure  for cornea transplants called DSEK (Descemet’s Stripping Endothelial Keratoplasty).  DSEK allows for quicker recovery from surgery and leaves the eye stronger and more resistant to injury.


DSEK
(Descemet’s Stripping Endothelial Keratoplasty)

A new treatment for Fuchs’ corneal dystrophy and corneal edema.

INTRODUCTION
The cornea is the clear window that covers the colored part of the eye. If this layer is not clear, vision will be blurry.

The inner layer of the cornea is made of a single layer of cells that do not regenerate. If this layer wears out or is damaged, the cornea will become cloudy and swollen resulting in poor vision.

Fuchs’ dystrophy is a condition that develops slowly over many years. Sometimes, the cornea becomes swollen after cataract surgery.

In some cases, a cornea transplant can treat these problems.   There are two options for corneal transplantation: traditional Penetrating Keratoplasty (PKP)  and Descemet’s Stripping Endothelial Keratoplasty (DSEK).

In PKP, the entire thickness of the cornea is removed and replaced.  In DSEK, only the diseased inner layer of the cornea is removed.

ANATOMY OF THE CORNEA
The cornea has 5 layers. The outermost layer is the EPITHELIUM. A corneal abrasion occurs when this layer is injured. The BOWMAN”S LAYER is just beneath the epithelium.  The STROMA is the thickest central part of the cornea. Scar tissue can block the light going through the cornea and cause blurred vision.

The innermost layer of the cornea is the ENDOTHELIUM. It is a single layer of cells that pumps fluid out of the cornea allowing it to be clear. Disease or damage to the endothelium causes swelling of the cornea producing blurred vision and a scratchy sensation. The endothelium attaches to DESCEMET’S MEMBRANE.

YOUR OPTIONS
You could elect to receive a Traditional Corneal Transplant  (PKP). The full thickness of the cornea including all 5 layers is removed and replaced. Multiple sutures are needed to secure the transplant. The sutures are fully or partially removed over a year. Often a contact lens is required for best sight. This procedure has been performed and improved over 60 years.

You could elect to have Descemet’s Stripping Endothelial Keratoplasty (DSEK).  This type of transplant replaces the diseased inner  layer, the endothelium, with a transplant that contains the endothelium,  Descemet’s membrane and a small amount of Stroma. Only the thinner layer containing the endothelium is transplanted.

DSEK is a relatively new corneal transplantation procedure. DSEK has been performed in the United States for less than 5 years. Dr. Friedberg has been performing Traditional Corneal Transplantation for 18 years and DSEK since 2006.

POTENTIAL ADVANTAGES OF DSEK
Compared to Traditional full-thickness corneal transplant (PKP):

  1. A smaller incision is used for DSEK and only one or two stitches are usually needed.
  2. Healing is faster with DSEK (3 to 6 months) compared to nearly a year for PKP,
  3. After DSEK the glasses prescription doesn’t usually change significantly. After PKP, the eyeglass prescription can be severe and some patients require a contact lens for best vision.

POTENTIAL DISADVANTAGES OF DSEK

  1. The surgery is relatively new and the long-term results are not yet known.
  2. The transplanted cornea may not stick to the inner surface of the cornea and an additional air injection may be required one or more times.
  3. Rejection can still occur.
  4. The graft could need to be replaced if it will not stick.
  5. The vision may be worse after surgery than before surgery if the cornea does not stick or suffers rejection.

POTENTIAL RISKS OF DSEK AND PKP

  1. As with all surgeries, there can be infection, retinal detachment, glaucoma  and other problems requiring additional surgery.
  2. Blurred vision while healing can interrupt work schedules and may limit driving.