What is a Cornea? The Cornea is the clear window of the eye that covers the colored iris and round pupil. The Cornea and human lens focus the light on the retina that lines the back of the eye so we can see. If the cornea is damaged it may become scarred or swollen. The damaged Cornea scatters or distorts the light, resulting in blurred vision, glare and sometimes pain. Other conditions that affect the smoothness and clarity of the cornea require Corneal transplant. These conditions include Keratoconus, a steep curving of the cornea and hereditary corneal disease like Fuchs' dystrophy.
Over 40,000 corneal transplants are performed in the United States each year. Corneal transplant is the most common and successful transplant surgery. The surgery is usually done on outpatient basis. The operation is painless and you will not see the surgery. Frequently local anesthesia is used. The eye lid is kept open with an speculum. The diseased or injured cornea is removed in a circular fashion. Other procedures, like cataract surgery, if indicated, are performed and then the clear donor cornea is sutured in the place of the diseased cornea. The eye is patched and patient is seen in the office the following day.
Like any other surgery, complications of corneal transplants include infection and bleeding. Corneal transplants are rejected 5 - 30 percent of the time. The rejected cornea swells and vision deteriorates. Warning signs of rejections are:
• Decrease vision
• Light sensitivity
Most rejections can be reversed if treated promptly. A corneal transplant can be repeated. The rejection rates are higher in the repeated transplants than the first time. Vision may continue to improve up to a year after surgery. Sutures are usually removed one year after the surgery and the astigmatism is corrected if it is indicated. A successful corneal transplant requires the care and attention of both patient and physician.
Descemet’s stripping endothelial Keratoplasty (DSEK)
Sometimes it is called a partial cornea transplant and can be used to treat corneal swelling after cataract surgery or from Fuch’s dystrophy. DSEK replaces only the damaged cell layer instead of the entire thickness of the cornea. In the procedure, the Descemet's membrane is removed and replaced with that of a donor. Due to the small incision, frequently, there is no need for sutures. This contributes to the faster visual recovery. DSEK is becoming more and more popular and will in time become the Gold Standard.
Advantages of DSEK
•Closed eye surgery with less complication
•Fast visual recovery
•Graft can dislocate early after surgery requiring intervention
We at the South Florida Laser Eye Center perform this procedure regularly and have had excellent outcomes.