Improve Your Cornea Clarity, So Critical for Better Vision
The cornea is the transparent window in front of our eyes that transmits and refracts the incoming light to them. A broad spectrum of corneal diseases and conditions can affect visual function. Even a mild opacity or haze – as with scars or severe dry eye – or changes in the steepness of the cornea from a disease such as keratoconus can significantly compromise vision. Not surprisingly, many eyes with significant corneal disease suffer severe visual problems. In these situations, that worst case scenario is called cornea blindness. Corneal transplantation could be the only thing to save the eye!
For several decades, cornea surgeons have been able to replace a diseased cornea with a new healthy cornea, in a procedure known as a full thickness corneal transplantation, or Penetrating Keratoplasty. Of course, surgical techniques and instruments have improved drastically over the past 20 years. Although full thickness corneal transplantation still is employed by cornea surgeons to address some corneal diseases, today it is possible to perform a partial thickness corneal transplantation. We can selectively replace the only layer of the cornea that needs to be replaced, and this is the basis of Endothelial Keratoplasty and Anterior Lamellar Keratoplasty. Here is a list of the conditions that might require a corneal transplantation:
· Corneal scar or opacity
· Corneal edema after multiple eye surgeries, like glaucoma or
· Corneal edema due to Fuch’s Endothelial Dystrophy
· Corneal haze due to stromal dystrophy
· Keratoconus and other corneal ectasias
· Corneal perforation and severe thinning
Deep Anterior Lamellar Keratoplasty
Deep Anterior Lamellar Keratoplasty, or DALK, is a selective corneal transplantation that replaces all anterior parts of the cornea up to the Descemet’s membrane. So Descemet’s and the endothelial cell layers of the host remain intact. This technique is ideal for keratoconus and anterior stromal scars. The main advantages of DALK over full thickness keratoplasty are:
· Chance of endothelial rejection is eliminated
· Stronger structural integrity
Descemet’s Membrane Endothelial Keratoplasty (DMEK) is a new advance in corneal transplantation. This surgical procedure removes the innermost layer of the cornea, called Descemet’s membrane, and the endothelial cells. These are replaced with an identical layer of a donor cornea. With a similar procedure, Descemet’s Stripping Endothelial Keratoplasty, or DSAEK, the graft thickness of the replacement varies between 50 to 150 microns and includes some corneal stroma, Descemet’s membrane and endothelial cells. By contrast, in the new DMEK procedure, the replacing graft would be the same anatomically and includes only Descemet’s membrane and overlying endothelial cells.
Advantages of DMEK over DSAEK
There are several proven benefits of DMEK over the DSAEK procedure, as highlighted below.
· Faster recovery
· Lower graft rejection rate
· Better quality of vision
· Minimal refractive changes after transplantation
Exploring New Surgical Vistas
You might find that one of these new techniques of corneal transplantation can help you. Certain subsets of various corneal conditions can be addressed using artificial corneas or keratoprostheses. Our skilled cornea surgeons, with proven expertise in these innovative surgeries, can inform you about your different options and their corresponding advantages.