Corneal Transplants

A corneal transplant, or a corneal graft or a penetrating keratoplasty, traditionally involves the removal and replacement of the central portion of the diseased cornea using a matched donor corneal tissue. 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.

In keratoconus, a corneal transplant is warranted when the cornea becomes dangerously thin or when one can no longer achieve sufficient sight with contact lenses due to the steepness of the cornea, corneal scaring or contact lens intolerance. Contact lens intolerance occurs when the steepened irregular cornea can no longer be fit with a contact lens or, if the patient can no longer achieve functional vision or can successfully undergo an Intacs procedure.

A common indication for keratoplasty is severe keratoconus. A physician decides when to recommend keratoplasty for the keratoconic patient. This is often not a simple, straight-forward decision. Keratoplasty for keratoconus is highly successful; however, there is a long recovery period (usually 12-18 months) and the surgery has a risk of severe ocular complications.

DSEK/DSAEK/DMEK

Endothelial keratoplasty (EK) has been introduced by Melles et al in 1998. Today there are three forms of EK. Deep Lamellar Endothelial Keratoplasty (DLEK) in which the posterior part of the recipient cornea is replaced by donor tissue. Descemet's Stripping (Automated) Endothelial Keratoplasty (DSEK/DSAEK) in which the diseased Descemet's membrane is removed and replaced by a healthy donor posterior transplant. DSEK/DSAEK uses only a small incision that is either self-sealing or may be closed with a few sutures. The small incision offers several benefits over traditional methods of corneal transplant such as Penetrating Keratoplasty. Because the procedure is less invasive, DSAEK leaves the eye much stronger and less prone to injury than full-thickness transplants.

Important:
A number of factors must be considered in deciding when to do a keratoplasty. One of the most important is the patient's functional vision. If the best acuity with contact lenses prevents a patient from doing his/her job or carrying out normal activities, the patient should ask if they are candidates for Intacs corneal implants or if their condition is too severe, a corneal transplant may be recommended. Only a physician can provide what is best for your situation.

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