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The cornea is the clear front of the eye that covers the colored iris and the round pupil. Light is focused while passing through the cornea, so we can see. To stay clear the cornea must be healthy.
The cornea can be damaged after a foreign object has penetrated the tissue, such as from a poke in the eye. At other times, bacteria or fungi from a contaminated contact lens can pass into the cornea. Situations like these can cause painful inflammation and corneal infections called keratitis. These infections can reduce visual clarity, produce corneal discharges, and perhaps erode the cornea. Corneal infections can also lead to corneal scarring, which can impair vision and may require a corneal transplant.
If the cornea is damaged it may become swollen or scarred. In either case, its smoothness and clarity may be lost. The scars, swelling or an irregular shape cause the cornea to scatter or distort light, resulting in glare or blurred vision.
The eyelid is gently opened. Looking through a surgical microscope, your doctor measures the eye for the size of the corneal transplant. The diseased or injured cornea is carefully removed form the eye. Any necessary additional work within the eye, such as removal of a cataract, is completed. The clear donor cornea is then sewn into place.
Corneal Transplants are generally performed on an outpatient basis. You will have a short stay in the recovery area and then be allowed to return home. You should plan to have a friend or relative drive you home.
A successful corneal transplant requires care and attention on the part of both patient and physician. However, no other surgery has so much to offer when the cornea is deeply scared or swollen. The vast majority of people who undergo corneal transplants are happy with their improved vision.
New techniques of corneal transplantation now offer patients safer, faster, economical alternatives and represent a dramatic improvement over traditional methods.
The front surface of the cornea is a thin layer of skin which is adhered to the tough, clear substance of the cornea known as stroma. This layered structure is compact and transparent because of a thin single layer of cells on the inside surface. These cells are known as the endothelium, and their purpose is to continually pump fluid out of the stroma to keep it compact and clear. An inherited disorder of the endothelium known as Fuch’s Endothelial Dystrophy is the leading cause of corneal clouding which requires an operation to restore corneal clarity.
Until the last few years, full-thickness corneal transplantation was the procedure performed to treat most disorders affecting corneal clarity. The drawbacks of induced astigmatism, unpredictable refractive changes, weakening of the eye and risk of graft rejection prompted development of faster, safer, and better solutions. The disorder of corneal clarity caused by disorders of the endothelium can be cured by replacement of that layer as opposed to the entire cornea.
A procedure known as Descemets Stripping Automated Endothelial Keratoplasty (DSEK) revolutionized corneal transplantation. In this operation, the abnormal endothelial layer is removed and replaced by a thin disc of donor endothelium placed inside the eye through a small peripheral incision. The tissue adheres to the back of the cornea because of the natural suction applied by the healthy endothelium. The improvement in corneal clarity begins immediately, and patients often are able to get new glasses one month after surgery. The risk of graft rejection is halved in comparison with full-thickness transplantation, and the possibility of globe rupture is significantly reduced. For many with corneal clouding, DSEK offers more predictable visual outcomes.
Over the last decade a lot of progress has been made in the successful outcomes of corneal transplants. The latest is a new procedure known as Descemets Membrane Endothelial Keratoplasty (DMEK). DMEK further improves this procedure by using a thinner disc of tissue made up of only endothelium and Descemet’s membrane. This tissue is more difficult to handle, but once in place provides improved visual outcomes, as well as, decreased rejection rates compared to both DSEK and full thickness cornea transplants. DMEK may be a better option for patients with Fuch’s Dystrophy and no other serious ocular problems.