What is a Cornea Transplant?

A cornea transplant (keratoplasty) is a surgical procedure to replace part of your cornea with corneal tissue from a donor. Your cornea is the transparent, dome-shaped surface of your eye that accounts for a large part of your eye’s focusing power. A cornea transplant can restore vision, reduce pain and improve the appearance of a damaged or diseased cornea.

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Corneal Transplants using DSAEK and DMEK

Descemet’s stripping automated endothelial keratoplasty (DSAEK) and Descemet’s membrane endothelial keratoplasty (DMEK) are partial thickness corneal transplants which replace primarily the endothelium (innermost portion of the cornea) rather than the full thickness of the cornea (as in standard corneal transplants). DSAEK and DMEK are indicated when there is corneal clouding due to a dysfunction of the endothelium but where the other layers of the cornea remain healthy. With Fuchs’ endothelial dystrophy or when there is swelling of the cornea after cataract surgery, it is the endothelium which is compromised.

What is the endothelium and how does it work?

The cornea is the clear dome that makes up the front part of the eye. It is about 1/10th of a centimeter thick and is composed of three primary layers: the epithelium, the stroma, and the endothelium. The epithelium is a thin surface layer. The stroma is composed mostly of fibrous proteins and acts like a sponge, absorbing fluid from inside the eye. The endothelium is a single layer of cells coating the inside portion of the cornea. Its job is to provide nutrients to the cells in the stroma and to make sure that the stroma has just the right amount of fluids. Too much fluid in the stroma can cause swelling of the cornea and decreased vision.

What is endothelial failure?

The cells of the corneal endothelium are very fragile. Two of the most common causes of endothelial failure are disease (like Fuchs’ Dystrophy) and decompensation following eye surgery, cataract or glaucoma surgery. Once an endothelial cell dies, it will not grow back. If an eye loses too many endothelial cells, it is not able to maintain the proper corneal thickness and clarity.

What is DSAEK?

DSAEK is a corneal transplant technique where the unhealthy, diseased, posterior portion of a patient’s cornea is removed and replaced with healthy donor tissue obtained from an eye bank. Unlike traditional corneal transplant surgery, the DSAEK procedure utilizes a much smaller surgical incision. DSAEK usually results in more rapid visual recovery and also reduces the risk of sight threatening complications that may occur with a corneal transplant, such as intraoperative expulsive hemorrhage or post-operative traumatic wound rupture.

What is the difference between DSAEK and DMEK?

DMEK is very similar to DSAEK, except that the donor tissue implanted does not include any stromal tissue. It is a pure replacement of endothelium. This tends to give better visual results and a quicker recovery; however, donor disc dislocations and failures are more common. You should discuss both options with your surgeon to determine which is best for you.

Advantages of DSAEK and DMEK compared to full-thickness corneal transplantation, Penetrating Keratoplasty (PKP)

  • Improved vision
  • The eye surface is kept intact, thus remaining more resistant to injury and infection
  • There is minimal change in refraction because only the endothelial layer (~5% of the cornea) is replaced
  • Suture-related problems are significantly reduced/can be eliminated
  • Less risk than a traditional corneal transplant
  • Visual recovery is significantly faster and better compared to corneal transplantation
  • Less astigmatism compared to corneal transplantation
  • Reduced discomfort
  • Potential improvement in lifestyle functioning

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