Cornea Transplant
Endothelial, Anterior Lamellar
(Penetrating Keratoplasty)
A corneal transplant surgery may restore vision in otherwise blind eyes. The most common indication for this procedure is corneal decompensation following cataract surgery. Other common indications include: corneal ulceration, corneal scars, keratoconus, herpes simplex and varicella zoster viral opacifications, Fuchs Endothelial Dystrophy, and congenital abnormalities of the cornea.

The Corneal Transplantation Procedure

A complete preoperative evaluation is required prior to surgery. Every attempt to confirm retinal and optic nerve function is made prior to the procedure, so as to avoid unnecessary surgery.

The majority of adult patients have surgery under local anesthesia. General anesthesia is often required for children, anxious, or uncooperative patients. After the anesthetic is given, the surgeon may sew a ring to the ocular surface to support the eye. The donor cornea is prepared using a punch or corneal trephine to create the corneal button. The corneal button becomes the transplanted cornea. The diseased, or scarred, cornea is then removed using a corneal trephine, creating a recipient site for the transplanted tissue. Finally, the donor cornea is gently sewn into place with ultra-fine sutures (approximately one-third the thickness of human hair).

Corneal transplantation may be combined with other procedures, particularly cataract extraction with intraocular lens implantation.

Patients should expect a very gradual recovery of vision. In fact, the best vision may not be obtained for six to 12 months or more following surgery. Vision may, however, be improved immediately after surgery. The surgeon will occasionally remove some sutures from the cornea within a few months after surgery. In general, sutures are removed to help alleviate astigmatism once the cornea shows signs of being securely healed into place.

Endothelial Transplant
(Posterior Lamellar Keratoplasty and Deep Lamellar Endothelia Keratoplasty)
An exciting advance for people with diseased corneas is now available. For certain patients, posterior lamellar keratoplasty (PLK) and deep lamellar endothelial keratoplasty (DLEK) are new surgical options for the treatment of defective corneal pump cells. The most common indications for endothelial transplantation include Fuchs’ Endothelial Dystrophy and corneal decompensation after cataract surgery.

The Endothelial Transplantation Procedure

Both PLK and DLEK involve replacing some of the defective inner layers of the cornea with healthy donated tissue. Both have a relatively small incision size when compared to traditional cornea transplants and offer a much lower risk of astigmatism. While both PLK and DLEK result in the placement of new pump cells inside the eye, the latter requires more dissection of the recipient and potentially more time in the operating room. PLK surgeons frequently perform an efficient stripping of the defective cells to prepare for insertion of the healthy endothelial pump cells.

Endothelial transplantation has the potential of rapid visual recovery while still maintaining the structural integrity of the eye. Frequently, two or less sutures are used during the entire procedure. The long-term risk of eye rupture from trauma appears to be much lower with this procedure than with traditional cornea transplants.

Postoperatively, patients should expect a very gradual recovery of vision. In fact, the best vision may not be obtained for six to 12 months or more following surgery. Vision may, however, be improved immediately after surgery. Patients are usually able to return to normal activities on the second day following surgery.

Endothelial transplantation can only be used to treat specific conditions of the cornea. A comprehensive examination of the cornea is necessary to determine if this new procedure is an appropriate alternative to traditional corneal transplantation.

Keratoconus is part of a family of disorders involving abnormalities in the shape of the cornea, the clear front of the eye. Affecting millions, keratoconus is characterized by an abnormally steep and irregularly shaped cornea, which makes vision blurry. Changes from keratoconus are occasionally mild, but severe disease may cause thinning and scarring along the visual axis.

The symptoms of keratoconus vary with the degree of thinning, astigmatism, and scarring. Early on, patients typically have astigmatism correctable with glasses or soft contacts. As the disease progresses, gas permeable contact lenses may be needed to obtain the best vision. Light sensitivity, sudden pain, and corneal swelling are all common in severe keratoconus. It is important to note that each eye can be affected differently and may stabilize after some time.

If contact lenses cannot adequately compensate for the abnormal keratoconus shape, surgery is usually recommended. Full thickness and partial thickness cornea transplants have been time-tested remedies for keratoconus. By replacing the steep cornea with a sutured donor cornea, a relatively normal curvature can be restored. Newer therapies such as corneal inserts warrant further analysis.

If you would like to know more about options keratoconus, please fill out our contact form, and we will gladly help to answer any questions.

Dry Eye Syndrome
It is one of the most common problems treated by eye physicians. It is usually caused by a problem with the quality or amount of the tear film that lubricates the eyes. Risk factors for developing dry eyes include: older age, certain systemic medicines, conditions of the ocular surface, and female gender.

Dry eyes can cause a gritty, sandy sensation, burning, stinging, or itching. Some people notice a sticky feeling upon waking from sleep. Occasionally, a dry eye can actually seem watery due to reflex tearing from irritation. Longstanding dry eye can lead to poor vision, redness, and altered sensation of the ocular surface.

The first line of treatment for dry eye syndrome is usually lubrication with artificial tears. There are a multitude of artificial tears available, and trial and error is usually the best way to find a favorite. If artificial tears are applied more than four times per day, greater treatment is probably necessary.

For more advanced dryness, prescription anti-inflammatory therapy can actually increase tear production. The prescription eye drop, Restasis ®, has been shown to improve the symptoms of dry eye as well as the ongoing microscopic damage from this condition.

Eye doctors often recommend temporary closure of the tear drainage system to increase the volume of the tear film. Closure is accomplished with a small plug, which fits comfortably into the tear drainage system. Placement of plugs is a quick and painless office procedure.

If you would like to know more about options for dry eye treatment, please fill out our contact form, and we will gladly help to answer any questions.

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