The cornea is a remarkable structure that helps to focus light and protect the internal structures of your eye. The shape of the cornea is important to the focusing of light on the retina in the back of the eye. A properly shaped cornea and healthy lens will allow this light to focus clearly, providing crisp vision. It is also important that the cornea remain clear so the light can pass through to the retina without being interrupted. If the cornea gets hazy or cloudy, or if the shape of the cornea becomes irregular, vision can be impaired. Some causes of this include age, trauma or disease. When vision is impaired enough to affect a patient’s daily functioning, it may need to be totally or partially replaced by a corneal transplant procedure.
Penetrating Keratoplasty (PK)
If the entire thickness of the cornea is unhealthy, a full thickness corneal transplant may be required. This is called a penetrating keratoplasty (PK). Where the DSAEK procedure is focused on transplanting only the endothelial cell layer of tissue, during a PK procedure a perfectly round circle of cornea is removed from the patient and replaced with donor tissue. This new cornea is sutured into place with a stitch that is thinner than a human hair, for a comfortable healing process.
What to Expect
Prior to corneal transplant surgery patients receive a full evaluation and testing at Carolina Cataract & Laser Center so that Dr. Vroman and Dr. Budev can best determine the patient’s treatment options, including the need for corneal transplant surgery. One week prior to surgery the staff at Carolina Cataract & Laser Center begins the process of procuring donor corneal tissue in preparation for the patient’s surgery and schedules all appropriate OR time at the surgical facility. As the statewide medical director of Lifepoint Eye Bank, David Vroman, MD, is not only one of the two Carolina Cataract & Laser Center surgeons performing these transplant procedures, he also provides statewide oversight of the entire corneal tissue program, ensuring the best quality possible for tissue preparation and patient safety.
On the day of surgery, the patient will arrive at the surgery center approximately one hour prior to the surgery for preparation. The patient must not eat anything after midnight the day before surgery and will begin pre-operative medications three days prior to surgery as instructed. Prior to the patient’s surgery the surgeon will prepare for surgery by determining the type of tissue to be used and selecting the technique needed to ensure the best surgical outcomes possible. During the surgery patients may hear the surgeon talking and feel pressure around the eye, but there is no pain and most patients report that the experience was comfortable. After the approximately one hour surgery, the patient will rest at home for the remainder of the day.
Patients of Carolina Cataract & Laser Center are showing remarkable results with the corneal transplant procedure, with most achieving 20/40 vision or better between 6-12 months after surgery. After three to four months, sutures will be slowly removed over several visits in order to make the shape of the cornea as round as possible. As patient results will vary, glasses are prescribed as needed at the end of this healing period. Patients will return to the Carolina Cataract & Laser Center clinic for follow up at one day post operative, one week, three weeks and then as determined by your surgeon.
As with any operative experience, there are always risks and benefits which will be discussed in detail with the surgeon prior to surgery. If at any time the patient experiences redness, pain, loss of vision or any other concerns, our office should be contacted at (843) 797-3676. Broken sutures, infections, or graft rejection can occur at any time and needs to be addressed immediately. In most instances, there are no complications and better vision is achieved in the end.
Lamellar Keratoplasty (LK), Deep Anterior Lamellar Keratoplasty (DALK)
At times, the front portion of the cornea can be damaged while the endothelium is healthy. In ideal circumstances, only the diseased anterior portion of the cornea will be transplanted through either a Lamellar Keratoplasty (LK) or Deep Anterior Lamella Keratoplasty (DALK) procedure. The risks and follow up care are similar to a PK. This alternative is a solution in special situations.
New technologies have made this an exciting time for corneal transplantation. Traditional corneal transplantation, known as Penetrating Keratoplasty (PK), is a highly refined procedure with positive overall outcomes. Traditional corneal transplantation techniques have evolved as well, allowing surgeons to provide even newer techniques, such as DSAEK, to patients with specific corneal needs.
The cornea is a remarkable structure that helps to focus light and protect the internal structures of your eye. The shape of the cornea is important to the focusing of light on the retina in the back of the eye. A properly shaped cornea and healthy lens will allow this light to focus clearly, providing crisp vision.
Carolina Cataract & Laser Center surgeons David Vroman, MD and Millin Budev, MD currently perform all corneal transplant and DSAEK procedures at the Trident Eye Surgery Center in North Charleston.