Cornea Services cont.
An endothelial keratoplasty is a surgical procedure that removes the abnormal inner lining of the cornea, known as the endothelium, and replaces it with a donor cornea.
The cornea is the clear covering of the front of the eye which bends, or refracts, light rays as they enter the eye. If the cornea is not shaped properly or is somehow clouded, whether because of injury, infection or disease, visual acuity is compromised, and a corneal transplant may be recommended.
The three surgical methods of an endothelial keratoplasty include the following:
- Descemet’s stripping and automated endothelial keratoplasty, known as DSAEK
- Descemet’s stripping endothelial keratoplasty, known as DSEK
- Descemet’s membrane endothelial keratoplasty, known as DMEK
Benefits of an Endothelial Keratoplasty
An endothelial keratoplasty requires a much smaller incision than a regular cornea transplantation and results in fewer risks and a shorter recovery time. Recovery of vision is quicker with an endothelial keratoplasty and there is less of a restriction on activities. There is less of an issue with astigmatism with an endothelial keratoplasty and there are minimal or no suture problems.
Candidates for Endothelial Keratoplasty
Endothelial keratoplasty is commonly performed on patients with Fuchs’ Dystrophy, which is an inherited eye disease that causes the cells of the endothelium to deteriorate, resulting in distorted vision and corneal swelling. As the condition progresses, vision will continue to worsen because damaged cells are unable to grow back.
Endothelial keratoplasty has also been performed on patients who have the following conditions:
- Swelling of the cornea after cataract surgery
- Clouding of the cornea
- Graft failure from a previous cornea transplant
The Endothelial Keratoplasty Procedure
During the endothelial keratoplasty procedure, the surgeon will make an incision in the sclera, the white part of the eye. This incision allows the surgeon to access the cornea, and remove the damaged endothelial tissue using a microkeratome blade, the same instrument that is used during LASIK surgery. The donor tissue is then folded and implanted inside the eye.
After the donor tissue has been placed, it will either unfold on its own or be unfolded by the surgeon. An air bubble is injected to properly position the graft. This procedure is performed with a topical anesthetic to minimize any potential discomfort. The actual procedure takes up to 45 minutes to perform.
Recovery from Endothelial Keratoplasty Procedure
After the procedure, the patient will be moved to a recovery room and monitored before being allowed to go home. A prescription will be given for antibiotic and steroid eye drops, which are to be taken during the next few days to help with healing. Post-operatively, the patient will be required to lie down, face up, for the next 24 hours. A follow-up appointment will need to be scheduled.
Most patients notice improvements to their vision within the first 2 weeks after surgery, with results continuing to develop during the next 4 to 6 months. This is significantly faster than with the traditional corneal transplant procedure, which may take 6 to 12 months before effective results are achieved. Other existing eye conditions may slow or hinder the improvement of vision after the procedure.
Risks of the Endothelial Keratoplasty Procedure
While the procedure is considered safe for most patients that have cornea damage, there are certain risks involved with any type of surgical procedure, including:
- Transplant rejection
- Redness of the eyes
- Sensitivity to light
- Blurred vision
If these or any other symptoms are experienced after the procedure, the patient should immediately contact their doctor to prevent any permanent damage.
A corneal transplant, also known as a corneal grafting or keratoplasty, is the surgical removal of a damaged or diseased cornea and the implantation of a donated human cornea, usually obtained from an eye bank. The cornea is the clear covering of the front of the eye which bends, or refracts, light rays as they enter the eye. If the cornea is not shaped properly or is somehow clouded, whether because of injury, infection or disease, visual acuity is compromised, and a corneal transplant may be recommended.
During a penetrating keratoplasty procedure, or PKP, the central two-thirds of the damaged cornea is surgically removed and replaced with donor tissue that is sutured in place.
Candidates for PKP
An improperly curved cornea may be corrected surgically for patients whose curvature is too steep or flat to be treated with other methods, or when extensive damage has occurred due to either disease, trauma, infection or surgery.
PKP may be performed on patients with the following conditions:
- Corneal edema
- Rejection of a previous graft
- Vision loss
- Corneal ulceration
- Corneal dystrophy
- Traumatic injury
Penetrating keratoplasty replaces the entire thickness of the cornea with a donor graft. The new cornea is stitched into place, and stitches are usually removed after one year. It may take this long for vision to be restored to satisfactory levels as well, requiring many patients to wear glasses or contact lenses after this procedure.
Complications of PKP
As with any type of surgical procedure, there are certain risks associated with PKP, including:
- Graft rejection
With new advances in the procedure, PKP is not performed as often as it had been. The surgeon will determine whether or not this procedure is appropriate after a thorough evaluation of the patient’s eyes and a review of any pre-existing conditions.
Punctal plugs, also known as punctum plugs, lacrimal plugs or occluders, are a method of treating dry eyes. Punctal plugs can relieve dry eye symptoms when eye drops or ointments fail. Punctal plugs are placed in the opening of the tear duct, reducing the natural drainage of tears and keeping the eyes moist. Punctal plugs can be a temporary or permanent solution to dry eyes.
Typically, a temporary or dissolvable punctal plug is implanted in the lower drainage channel of the eye, which is responsible for 80 percent of the eye’s tears. These temporary plugs will usually last a few days to several months. If there is a successful response to the temporary punctal plug, a more permanent punctal plug is implanted.
Punctal plugs come in a few different shapes and sizes, and are no larger than a grain of rice. The plug may be placed in the lower or upper eyelid or both eyelids. Implantation takes only a few seconds in a physician’s office.
To learn more about our Ophthalmology Services, please contact us today to schedule an appointment!