Corneal Transplants

Expert Corneal Care in Bradenton, Sarasota, Ellenton & Sun City Center, FL

For a consultation with Fellowship Trained Corneal Surgeon Dr. Brian Foster, click here or call 1-866-865- 2020 to schedule an appointment.

Corneal Transplants

What is a Corneal Transplant and why would someone need one?
A corneal transplant is a surgical procedure that replaces the cornea or part of the cornea with corneal tissue from a donor eye. This is done usually when some type of corneal failure has occurred. Some types of corneal transplants include penetrating keratoplasty (traditional), DSAEK, and  DALK. It should be noted that sometimes even after a corneal transplant, good vision may be limited if there has been severe scarring or if the body rejects the transplant.

DSAEK

DSAEK is a partial thickness corneal transplant procedure in which only the diseased inner cell layer of the cornea is replaced. The inner layer of the cornea is lined by cells (endothelium) that serve to pump fluid out of the cornea and keep it clear and thin. These cells can be damaged by prior surgery, inflammation, or by a condition known as Fuchs’ Dystrophy. As endothelial function declines the cornea swells and becomes cloudy, decreasing vision. If swelling becomes severe, blisters (bullae) can develop on the cornea and cause pain and infection. As these conditions progress, surgery is often required to help with pain or improve vision.

How is Traditional Corneal Transplant (Penetrating Keratoplasty) different from DSAEK?
With a traditional, ‘full thickness’ corneal transplant surgery, a circular portion is removed from the center of the diseased cornea. A matching circular area is removed from the center of a healthy, clear donor cornea, and is then sutured into place, replacing the diseased one. With the advancement of DSAEK corneal transplant, the treatment has now gone from close to a year recovery to about a six-week recovery with the newer techniques.

How is DSAEK performed?
Dr. Foster measures your eye and the donor cornea tissue is cut to the appropriate size for your eye. A small incision is made in your cornea (much like cataract surgery) and the diseased endothelial cell layer is carefully removed. The donor tissue is then introduced into the eye and an air bubble is used to apply it to the back of the cornea. The air bubble remains for 1-2 days helping to keep the donor tissue in place. Surgery generally takes less than 30 minutes and you are able to return home. A protective eye shield is kept in place until Dr. Foster sees you the next day.

What are the advantages of DSAEK?
Compared to full thickness corneal transplants, there are many advantages to DSAEK. Since 95% of the corneal structure is unchanged, patients tend to have much less astigmatism and a much stronger cornea. Healing usually takes a few weeks and is much quicker than healing of a full thickness transplant.

What are the disadvantages of DSAEK?
Occasionally the donor tissue comes loose and requires repositioning and the placement of a second air bubble. Once the graft has been attached for a few days, there is no risk of dislocation at a later point. In some patients with severe corneal swelling, scarring is present that may limit best possible vision even though the swelling resolves.

What can I expect after surgery?
Initially the vision will be quite blurry but will clear over the first several weeks. The eye may be red, sore, light-sensitive, and watery for the first week or two after surgery. During the first 24 hours after surgery, Dr. Foster will ask you to keep your eye looking at the ceiling as much as possible to help graft adherence. It is also very important not to rub or touch the eye for the first few weeks.

Steroid eye drops are used to help the eye heal after surgery and prevent graft rejection for the long term. The risk of graft rejection is typically 5% or less but is high enough that long-term drops (usually once a day) are required. Dr. Foster will keep a close watch over your healing process and will customize an anti-rejection regimen appropriate for you.

What is DALK?

Dr. Foster is one of only a few surgeons in the country skilled in Deep Anterior Lamellar Keratoplasty or DALK. Many keratoconus patients are candidates for this modern corneal transplant technique because the inner layer of corneal cells (endothelium) is healthy. During the procedure, Dr. Foster removes the top 95% of the cornea and replaces it with healthy donor tissue. Patients keep their own healthy endothelial cells and the eye maintains greater strength with a lower risk of rejection than ‘full thickness’ transplants.

Even with these modern techniques, a transplanted cornea heals slowly. It can take up to a year for good vision after corneal transplantation. While a corneal transplant will relieve the symptoms of keratoconus, it may not provide you with flawless vision and often rigid contact lenses are still required to see your best. However, of all conditions requiring corneal transplants, keratoconus has the best prognosis for clear vision.

For a consultation with Fellowship Trained Corneal Surgeon Dr. Brian Foster, click here or call 1-866-865- 2020 to schedule an appointment.

OR… if you are a keratoconus patient wearing contact lenses and would like to be seen for contact lenses, click here or call 1-866-865-2020 for an appointment with one of our Board Certified Optometrists that specialize in contact lens fittings for keratoconus patients.