Cornea

The cornea is a thin, clear, spherical layer of tissue on the surface of the eye that provides a window for light to pass through. In a healthy eye, the cornea bends or refracts light rays so they focus precisely on the retina in the back of the eye.

There are many diseases that can affect the cornea, causing pain or loss of vision. Disease, infection or injury can cause the cornea to swell (called "edema") or degrade (become cloudy and reduce vision). Common diseases and disorders that affect the cornea include:

  • Allergies
  • Bullous Keratopathy
  • Conjunctivitis ("Pink Eye")
  • Dry Eye
  • Corneal Dystrophies including Fuchs' Dystrophy and Lattice Dystrophy
  • Glaucoma (High Eye Pressure)
  • Infections
  • Keratitis (Viral Inflammation)
  • Keratoconus
  • Ocular Herpes
  • Pterygium
  • Shingles (Herpes Zoster)
  • Stevens-Johnson Syndrome

Treatment for corneal disease can take many forms, depending on the underlying problem as well as the patient's preferences. Some conditions resolve on their own and many can be treated with medication. If the cornea is severely damaged or if there is a risk of blindness, a corneal transplant may be recommended to preserve vision.

Corneal Transplant - DSAEK

The cornea is the clear covering of the front of the eye which bends, or refracts, light rays as they enter the eye. For clear vision to occur, the cornea must have the correct shape and clarity to focus incoming light rays precisely on the retina at the back of the eye. When the cornea becomes cloudy or misshapen from injury, infection or disease, transplantation may be recommended to replace it.

There are several different corneal transplant procedures available to help restore vision in patients with corneal problems. The traditional corneal transplant procedure involves replacing the entire damaged cornea with a healthy one from a human donor, which is usually obtained from an eye bank. However, technological advances have allowed for the development of specialized procedures that replace only the damaged part of the cornea, while leaving the healthy parts intact.

Short for Descemet's stripping and automated endothelial keratoplasty, DSAEK replaces only the innermost layers of cells within the cornea, known as the endothelium and a minimal amount of posterior stroma. This allows the procedure to be performed through a much smaller incision with shorter recovery times and fewer risks than a traditional corneal transplant.

DSAEK is commonly performed on patients with Fuchs' Dystrophy, an inherited eye disease that causes the cells of the endothelium to deteriorate, resulting in distorted vision and corneal swelling. As this condition progresses, vision will continue to worsen as damaged cells cannot grow back.

DSAEK Procedure

During the DSAEK procedure, your surgeon will make a small incision in the cornea, the front clear part of the eye. This incision allows the surgeon to access the cornea and remove the damaged endothelial tissue using special surgical instruments. The donor tissue is then folded and implanted into the eye and the incision is closed with one or more sutures (stitches).

After the donor tissue has been inserted into the eye, it will either unfold on its own or be unfolded by the surgeon. An air bubble is injected into the eye in order to properly position the donor corneal graft. This procedure is performed with both a topical anesthetic and an injectable anesthetic to minimize any potential discomfort. The actual DSAEK procedure only takes about 20 to 30 minutes to perform, although patients should plan on being at the surgical facility for about two hours.

Recovery from DSAEK

After the DSAEK procedure, patients will be moved to a recovery room, where they will be monitored for about 30 minutes before being able to go home. Your surgeon will prescribe antibiotic and steroid eye drops to be used as the eye heals. You will need to return to your doctor the next day for a follow-up appointment.

Most patients notice improvements to their vision within the first two weeks after surgery, with results continuing to develop over the next four to six weeks. This healing process is significantly faster than the traditional corneal transplant procedure, which may take six to 12 months before effective results are achieved. Other existing eye conditions may slow or hinder the improvement of vision after the DSAEK procedure. Your ophthalmologist will have an extensive discussion with you about your eyes and what your individual expectations should be.

Risks of DSAEK

While the DSAEK procedure is considered safe for most patients with cornea damage, there are certain risks involved with any type of surgical procedure, including infection, bleeding and more. Although rare, there is a risk of transplant rejection, which may result in redness, sensitivity to light and blurred vision. If you are experiencing these or any other symptoms after DSAEK, you should contact your doctor to prevent any damage from occurring.

To learn more about the DSAEK corneal transplant procedure, and to find out whether or not this procedure is right for you, please call us today to schedule a consultation with one of our experienced doctors.