Carlton Fenzl, M.D.
A corneal transplant is needed when the clarity of cornea, the first structure that light penetrates as it enters the eye, is such that vision cannot be corrected with eyeglasses or contact lenses, or if painful swelling cannot be relieved by medications or special contact lenses. Trauma or injury, infections, a hereditary condition called Fuchs’ dystrophy, and Keratoconus can all cause corneal failure. Over the last decade a lot of progress has been made in the successful outcomes of corneal transplants. The latest procedure is known as Descemets Membrane Endothelial Keratoplasty (DMEK).
More than 10 years ago surgeons moved away from full-thickness corneal transplantation in an effort to improve patient comfort, healing time, and visual results. 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 introduction of DSAEK (Descemets Stripping Automated Endothelial Keratoplasty) revolutionized corneal transplantation. The front surface of the cornea is a thin layer of skin which adheres 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. In this operation, the abnormal endothelial layer is removed and replaced by a thin disc of donor endothelium and stroma 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.
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 DSAEK and full thickness cornea transplants.
BIO: Dr. Carlton Fenzl, with Eye Surgeons Associates, is certified by the American Board of Ophthalmology and received subspecialty credentials in diseases and surgery of the cornea. He practices at ESA’s Rock Island and Geneseo, IL clinics and Bettendorf, IA clinic.
The material contained in this article is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider.