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Corneal Surgery
Corneal Transplant
A corneal transplant or penetrating keratoplasty (PKP) involves replacing a diseased or scarred cornea with a new one. When the cornea becomes cloudy, light cannot penetrate the eye to reach the light-sensitive retina. Poor vision or blindness may result. Corneal transplants are very common in the United States with about 40,000 performed each year.
In corneal transplant surgery, the surgeon removes the central portion of the cloudy cornea and replaces it with a clear cornea, usually donated through an eye bank. A trephine is used to remove the cloudy cornea. The surgeon places the new cornea in the opening and sews it with a very fine thread. The thread stays in for months or even years until the eye heals properly (removing the thread is quite simple and can easily be done in an ophthalmologist's office).
Following surgery, eye drops to help promote healing will be needed for several months, with certain drops being required indefinitely to prevent rejection of the donor cornea. After a 6-12 month period of recovery, patients may be fitted with eyeglasses or contact lenses.
Alternatives to Corneal Transplants
PTK
For diseases that only affect the surface of the cornea, phototherapeutic keratectomy (PTK) is one of the latest advances in eye care for the treatment of corneal dystrophies, corneal scars, and certain corneal infections.
Only a short time ago, people with these disorders would most likely have needed a corneal transplant. By combining the precision of the excimer laser with the control of a computer, doctors can vaporize microscopically thin layers of diseased corneal tissue and etch away the surface irregularities associated with many corneal dystrophies and scars. Surrounding healthy tissue is spared. New tissue can then grow over the now-smooth surface.
Recovery from the procedure takes a matter of days to weeks, rather than months as with a transplant. The return of vision can occur rapidly, especially if the cause of the problem is confined to the top layer of the cornea. Studies have shown close to an 85 % success rate in corneal repair using PTK for well-selected patients.
The PTK procedure is especially useful for people with inherited disorders, whose scars or other corneal opacities limit vision by blocking the way images form on the retina. PTK has been approved by the U.S. Food and Drug Administration.
LKP
For diseases that affect the anterior portion of the cornea but are not amenable to PTK, a partial thickness cornea transplant or lamellar keratoplasty (LKP) can be performed. This is the preferred technique for patients with keratoconus, a progressive gradual thinning of the cornea usually requiring a contact lens for best vision.
Recovery from LKP is similar to PKP but long term drop use to prevent rejection is often not necessary after one year of recovery.
DSEK
Descemet's stripping with endothelial keratoplasty (DSEK) is sometimes called a partial cornea transplant and can be used to treat corneal swelling after cataract surgery or from Fuchs' dystrophy (a familial dysfunction of the back surface of the cornea). DSEK replaces only the damaged cell layer instead of the entire thickness of the cornea. In the procedure, the inner most layer of the cornea (Descemet's membrane) is removed and replaced with that of a donor. Due to the small incision, there is limited need for sutures.
Recovery from DSEK is more rapid than convention corneal transplant. Eye drops are necessary to prevent rejection of the donor cornea. This has become the preferred technique in patients due to improved safety, potentially less rejection and more rapid visual recovery.
Intacs®
Intacs® corneal implants are clear, thin lenses similar to soft contact lenses that correct the shape of the cornea. The two half ring lenses are placed in the periphery of the cornea and work from within to reshape the cornea and correct mild nearsightedness. Intacs can also be used to treat keratoconus, a weakening and thinning of the cornea. Intacs implants are FDA-approved and usually give patients vision better than 20/20. Most patients no longer depend on glasses or contact lenses with Intacs. After implantation, there is no maintenance needed and the lenses cannot be felt or seen. They can be removed or replaced for new prescriptions.
Intacs implants have virtually no risk. They are an alternative to corneal implants or other surgery. Intacs are as simple as contact lenses and have results as strong as laser surgery. They do not weaken the cornea like LASIK and other laser options because no tissue is removed. Further vision correction, such as corneal implants or surgery, can be pursued later on if desired by the patient.
For more information please visit - http://www.intacsforkeratoconus.com
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