What is the Cornea?
The cornea is the front, outermost layer of the eye. It allows light into the eye and helps make images sharp and clear.
Corneal problems can happen to anyone, anytime, regardless of age of race. If something such as injury, disease, or infection damages the cornea,it can become cloudy or warped. A damaged cornea distorts light as it travels into the eye thus affecting vision. Sometimes, if the problem is severe enough, it can cause pain. In either situation a person's life can be seriously disrupted.
When an eye gets into this type of distress, the ophthalmologist will suggest a corneal transplant. The patient is placed on a transplant list and awaits a donor cornea from a local eye bank such as the Northeast Lions Eye Bank. Eye banks operate 24 hours a day and collect, evaluate and store donated corneas so they are available when needed. Corneas used in transplants are collected from recently deceased human donors. To protect the recipient of the cornea, the donor's cause of death and medical history are carefully screened. Blood tests are done to ensure that no contagious disease, such as AIDS or hepatitis, is present.
The cornea was one of the first parts of the body to be transplanted, and corneal transplants remain one of the most common and successful of all transplant procedures. During the procedure, the diseased or injured cornea is carefully removed from the eye and replaced with the donor cornea which comes from the eye bank.
A successful corneal transplant requires care and attention on the part of both the patient and the doctor. The healing time can take months, however, no other surgery has so much to offer when the cornea is severely damaged.
The cornea is the clear window at the front of the eye that bends and helps focus light onto the back of the eye (the retina) . In order for vision to be clear, the cornea must be clean and clear. Corneal disease can cause the cornea to become opaque or cloudy, preventing light from passing through clearly.
DSAEK is a new technique that can help some patients who previously required a full thickness corneal transplant. Both the conventional corneal transplant technique and DSAEK require use of a donor cornea, but DSAEK replaces only the diseased posterior section of the cornea. This procedure, which requires minimal suturing, allows more rapid visual restoration, less discomfort, and a reduced risk of some sight-threatening complications.
With a conventional corneal transplant, the full thickness of the cornea is completely removed, and a whole new donor cornea is sutured around the circumference of the cornea. These sutures can remain in the eye for over a year and can cause the cornea to take on an irregular shape during the healing process that is difficult to correct with glasses or contact lenses. This can result in less than optimum postoperative vision. DSAEK, on the other hand, involves removing only Descemet's membrane and the damaged endothelial cells and leaves the surface of the cornea intact. The surgery is usually performed on an outpatient basis.
What to expect on surgery day
You will arrive at the surgery center about an hour prior to your procedure. Once you have been checked in you may be offered a sedative to help you relax. You will then be prepared for surgery. The area around your eyes will be cleaned and a sterile drape may be applied around your eye.
A small incision will be made to allow the surgeon to strip away the diseased Descemet's membrane and damaged endothelial cells. Next, the bottom 10-20% of a donor cornea that has healthy endothelial cells attached to its Descemet's membrane will be inserted through the same incision. After it is placed in position, an air bubble will be used to hold the transplanted tissue in place.
After your DSAEK procedure
Immediately after the procedure, you will be taken into recovery where you will lie down for about an hour to let the air bubble continue to press against the tissue to secure it in place. Your eye will be patched before you leave. Antibiotic eye drops will be used for a week or so to help prevent infection, and a mild steroid eye drop will need to be used for a year or so to help prevent rejection.
With conventional corneal transplantation, your vision typically does not improve for many months, while with DSAEK, you may experience visual improvement within weeks. If you need transplants in both eyes, DSAEK allows you to have the second transplant within months, versus a year or more if you were to have a conventional transplant.
In order to make your DSAEK procedure a success, it is important that ALL scheduled appointments be kept and ALL medications are used as directed. Any pain, redness, or reduced vision should be reported immediately.
The decision to have DSAEK is an important one that only you can make. The goal of any vision restoration procedure is to improve your vision. However, we cannot guarantee you will have the results you desire. Rejection could happen at any time in the future. However, if the transplanted tissue should be rejected, it is usually possible to have the procedure successfully repeated.