Services | Corneal

Corneal Transplantation for Corneal and External Eye Diseases

The cornea is the clear covering on the front of the eye which bends helps focus light rays (vision) on the retina in the back of the eye. A cornea that is scarred or swollen will loose its clarity and impede proper transmission of light rays to the retina, resulting in poor vision

Corneal transplantation, or penetrating keratoplasty, is recommended for patients whose cornea is damaged due to disease, infection, or injury. Common indications for corneal transplantation are:

Central Scars (Keratoconus, chemical or mechanical injury, corneal ulcers, and herpes simplex virus keratitis)
Corneal edema (swelling)
Corneal Ulcers
Corneal Dystrophies
Traumatic injury

Transplantation involves replacement of the damaged cornea with a healthy donor cornea (obtained through an eye bank). Penetrating keratoplasty is 90% successful in patients with non-infectious causes.

During the procedure, a circular incision is made in the cornea. A disc of tissue is removed and replaced with healthy tissue that is sutured into place. Local or general anesthesia may be used, depending on the patient’s medical problems. The entire procedure lasts only 30-90 minutes. Visual recovery may take six to twelve months and entails topical eye-drops that prevent graft rejection and infection.

Any discomfort or change in vision after the procedure should prompt a visit to your surgeon. Rejection, infection, and breaking of sutures may cause pain or discomfort that should be treated immediately.

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Corneal Transplant - DSAEK or Descemets Stripping Endothelial Keratoplasty

The cornea is the clear tissue in the front of the eye that focuses light rays on the retina. For good vision to occur, the cornea must be smooth and clear. If it becomes cloudy or misshapen from injury, infection, or disease, corneal transplantation may be recommended.

There are several different corneal transplant procedures. The traditional corneal transplant procedure involves replacing the entire damaged cornea with a healthy one from a human donor tissue, obtained from an eye bank. However, technological advances have allowed for the development of specialized procedures that replace only the damaged portion of the cornea, leaving the remainder of the cornea intact.

Short for Descemet's stripping and automated endothelial keratoplasty, DSAEK replaces only the innermost layers of corneal cells, known as the endothelium. This allows the procedure to be performed through a much smaller incision with shorter recovery times and fewer risks than a traditional corneal transplant.

DSAEK is commonly performed on patients with Fuchs' Dystrophy, an inherited eye disease, in which the cells of the endothelium deteriorate, resulting in distorted vision and corneal swelling. As this condition progresses, vision and discomfort worsen.

DSAEK Procedure

During the DSAEK procedure, your surgeon will make a small incision to access the underside of the cornea and remove the damaged endothelial tissue. The donor endothelial tissue (prepared in the Eye Bank with a microkeratome blade) is then folded and inserted into the eye. The incision is closed with a few stitches, and the donor tissue is then unfolded, centered, and held in place by an air-bubble. This procedure is performed with a topical anesthetic to minimize any potential discomfort and takes only 30-45 minutes to perform. Patients should plan on being at the surgical facility for approximately two hours for recovery.

Recovery from DSAEK

After the DSAEK procedure, patients will be moved to a recovery room, where they will be. Your doctor will prescribe antibiotic and steroid eye drops to be used for the next few days as the eye heals. You will need to return to your doctor the next day for a follow-up appointment as well.

Most patients notice improvements in their vision within the first few weeks after surgery. Vision usually continues to improve for the next three months. This is significantly faster than visual recovery after a traditional corneal transplant procedure, which may take six to twelve months. Other existing eye conditions may slow or hinder the improvement of vision after the DSAEK procedure.

Risks of DSAEK

While the DSAEK procedure is considered safe for most patients with cornea damage, there are certain risks involved with any type of surgical procedure, including infection, bleeding, glaucoma and more. Although rare, there is a risk of transplant rejection, which may result in redness, sensitivity to light and blurred vision. If you experience these or any other symptoms after DSAEK, you should contact your doctor to prevent any damage from occurring.

Corneal Transplantation | DSAEK | Intacs Implantation | Manhattan | New York City

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