Dysfunction of the endothelium is one of the leading causes for corneal transplantation. Kenneth Goins, MD, an ophthalmologist in the Department of Ophthalmology and Visual Sciences at UI Hospitals and Clinics, talks about corneal transplants and a new procedure he is using.
Let's start with some basics here. What is a corneal transplant?
The cornea is the most important structure in the body. It is the gateway to the outside world. Put another way, it is a clear window that we look through each day. A corneal transplant is a replacement of a person's cornea with a donor cornea.
Who, in general, is the recipient of a corneal transplant?
The most common indication for corneal transplantation is failure of this endothelial pump layer to clear the cornea of fluid, which thereby results in corneal clouding and blurred vision. The hallmark disease that I treat at UI Hospitals and Clinics is Fuchs' endothelial dystrophy, which is an inherited disorder which begins to infect individuals between the fourth to fifth decades of life.
How were corneal transplants done traditionally?
Until recently, most corneal transplants required multiple stitches on the surface to secure the new cornea in position. Visual recovery after such a procedure is, more often than not, prolonged, taking up to 12 to 18 months and sometimes longer. Multiple office visits are required for removal of stitches to reduce astigmatism and improve vision.
What risk did that type of procedure have?
The traditional corneal transplant provides an extremely clear window for the patient to look through and a healthy endothelial layer to maintain clarity. But the wound size is large, which leaves the eye weakened.
How is the DSAEK procedure different from the more traditional approach?
For example, in a patient with Fuchs' dystrophy, the DSAEK procedure replaces only the diseased endothelial layer, or approximately 10 percent of the patient's cornea, leaving the eye stronger than with the traditional surgery.
With DSAEK, no surface stitches are required because an air bubble is placed into the eye, after which the patient lies flat for a period of time, thereby allowing the new cornea the time to adhere. This may all be done using topical anesthesia and a mild intravenous sedation as compared to more significant anesthesia with standard corneal transplantation.
Are patients who normally would not qualify for a corneal transplant qualifying for a DSAEK procedure?
DSAEK has not increased the number of patients who qualify for surgery, but instead, DSAEK has increased the number of corneal transplants being done each year because of the more rapid recovery of vision.
Can all eye specialists perform DSAEK procedures, or are there certain qualifications patients should look for when scheduling an appointment with their eye surgeon?
DSAEK is usually performed by corneal specialists who, through extensive training, practice, and research have demonstrated successful outcomes. In addition, research from our Iowa Lions Eye Bank has shown that more experienced surgeons usually have better outcomes.
If someone had more questions about corneal transplantation, is there someone they could call or a Web site that you would refer them to?
Of course, they can call our office at 319-356-2861 or e-mail through lasik@uiowa.edu, or visit us online. |
