The cornea is the clear covering of the front of the eye that focuses incoming light. For you to see accurately, your cornea needs to be clear and of the correct shape. When the cornea becomes cloudy or misshapen, a cornea transplant may be necessary to restore vision or repair the integrity of the eye.
Formerly the entire cornea had to be replaced with healthy donor tissue. But thanks to relatively recent advances, individual layers of the cornea can now be replaced, making for far shorter recovery periods and better outcomes. Dr. Groat performs Descemet’s stripping endothelial keratoplasty (DSEK) to replace the inner layer of the cornea.
What Is the Goal of DSEK Surgery?
DSEK is intended to transplant a healthy endothelial cell layer that will pump the fluid out of the cornea. It’s expected to restore corneal clarity and improve vision. This surgery corrects corneal endothelium failure, but it is not able to correct corneal scarring, thinning, or surface irregularity.
What Are the Advantages of Using DSEK Rather than Full Cornea Replacement?
This endothelial replacement, rather than the entire cornea, has a number of benefits for the patient:
- The eye surface is kept intact because only the diseased back layer of the patient’s cornea is removed. This keeps the cornea stronger and more resistant to injury and infection.
- There is minimal change in refraction and visual acuity because only the endothelial layer is replaced, rather than the entire cornea.
- Problems with sutures are significantly reduced or eliminated.
- Visual recovery is significantly faster and more dependable.
- Fewer risk factors are involved.
In contrast to DSEK surgery, a conventional corneal transplant requires 16 sutures and a prolonged recovery time. Plus, many patients report significant post-operative astigmatism after their transplant surgery. Full recovery can take from one to two years.
Am I the Right Candidate for a DSEK Procedure?
Not all patients with corneal pathology are candidates for DSEK with Dr. Groat. Candidacy depends on the patient’s decreased vision related to corneal swelling from poorly functioning endothelium. This usually comes as a result of Fuchs’ Endothelial Dystrophy, bullous keratopathy, iridocorneal endothelial syndrome, and other endothelial disorders.
How Long Does a DSEK Procedure Take?
A DSEK procedure is done with the patient under local anesthesia. The procedure takes just 45 minutes, about half the time needed for a traditional cornea transplant.
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What Should I Expect After My DSEK Corneal Transplant?
After your surgery, you will have a patch over your eye. You will rest for the remainder of the day. For as much of this time as is possible, you’ll need to lie flat on your back looking directly upward. This position keeps the air bubble against the corneal transplant. The procedure requires only a tiny incision that requires just a single suture (often not even a single suture is required). You will receive several drops to prevent infection, and to help the eye heal comfortably.
After just 48 hours there will only be limited restrictions to your activities. You’ll need to refrain from bending below the waist for three weeks following your surgery. Heavy lifting needs to wait three weeks, as well. You can usually drive within one week.
Your vision will be much better within one week, with 80 percent of your healing complete in one month. The remaining improvement will come over the next four to six months.
What Will My Vision Improvement Be With DSEK Surgery?
Your vision will be blurry after surgery due to swelling and the air bubble used to keep the transplant in place. The air bubble will be absorbed sometime within the first week, but swelling may persist for a month or two. As the swelling decreases, your vision will continue to improve. You may need new glasses while your eye is healing, but your vision will continue to improve. Patients without other eye problems usually achieve vision of 20/30 or better within a couple of months. Of course, this isn’t an absolute, and results can vary with different patients.
Is There a Risk of Rejection with DSEK?
You will use anti-rejection eye drops for a number of years after your DSEK procedure. The risk of rejection with DSEK is around 12 percent, compared to a 20 percent risk with full-thickness corneal transplants.
What can Cause Corneal Edema?
The cornea of the eye has multiple layers of tissue. The back layer of cells is the endothelium. This is the layer of tissue that pumps excess fluid from the cornea. Without proper drainage of the fluid, the clarity of the cornea can be diminished. The endothelium only has a specific number of cells. These never get replaced, so, if the corneal endothelial cells get damaged or die, the endothelial layer of the cornea is compromised.
Corneal edema may occur if there are not enough endothelial cells pumping excess fluid from this part of the eye. Two of the most common conditions that can result in irreversible endothelial cell loss are Pseudophakic Bullous Keratopathy and Fuchs’ Endothelial Dystrophy.
Pseudophakic Bullous Keratopathy can occur after cataract removal surgery and the insertion of an intraocular lens. After this procedure, it's possible that the clear cells of the endothelium behind the cornea may no longer function properly. This may happen due to intraoperative trauma to the delicate tissue around the cornea, intraoperative bleeding, or significant swelling after cataract removal surgery.
Fuchs’ endothelial dystrophy is a condition that increases a person's risk of Pseudophakic Bullous Keratopathy after cataract removal. As a normal part of the aging process, the cells that make up the endothelium can thicken and enlarge to some degree. An ophthalmologist will refer to these thicker, fatter cells as guttata. Because they occur in the later stages of life, guttata are normally not an issue. In Fuchs’ endothelial dystrophy, cells begin to go through this change many years, even decades sooner than they would naturally. As more cells undergo this transformation, fluid accumulation begins to occur in the cornea.
Does Corneal Edema Always Require Surgery?
Untreated corneal edema can cause significant visual disturbances. Fortunately, the condition is very treatable. Your eye doctor won't immediately recommend surgery unless you present with symptoms that are severe enough to warrant that approach. In some cases of very early dystrophy symptoms, no direct clinical treatment is applied. The doctor may take a "wait and watch" approach.
Depending on the reason you are experiencing corneal edema, your doctor may recommend one or more of the following:
- If you wear contact lenses, you may be advised to reduce the amount of time you have the lenses in your eyes. It may benefit you to wear eyeglasses instead for a number of days to enable corneal swelling to resolve without intervention. If the swelling is quite significant, it may take up to several weeks for the condition to improve.
- Evaporation strategies. Usually, corneal edema is worse in the morning after waking. This is because the eyes have been closed for several hours. Seeing that cloudy vision from corneal edema is caused by too much moisture at the front of the eye, your doctor may recommend sitting in front of a fan or blow dryer for a few minutes. It's important to remain a safe distance of a few feet away from the air source.
- Medication may be prescribed to resolve an underlying issue. Corneal swelling may be caused by inflammation or infection, both of which may be treated with corticosteroid eye drops. Medication may also be used as an approach if corneal edema is caused by high intraocular pressure (glaucoma).
- Bandage contact lenses. Contrary to the contact lenses that can cause corneal inflammation and swelling, bandage contacts are made to allow more oxygen through to the eye's surface. This may be a treatment option if corneal edema is caused by an injury to the eye.
Schedule A Consultation
Dr. Groat is an expert corneal surgeon who employs superlative experience and all the latest technologies available to provide you with the best cornea transplant treatment available anywhere. When you need surgery, you can trust Cape Fear Cataract & Cornea to develop the best customized surgical plan for you after discussing your needs and options. To schedule a consultation with our practice, call us at 910-769-4590 or contact us online.