Description of corneal transplantation
The cornea is the front clear surface of our eye similar to the window of our eye and it may need to be transplanted or replaced for a variety of reasons; these include an aging or dysfunction of the cells on the back of the cornea, also called Fuch's dystrophy or corneal decompensation, corneal scarring from previous infections, a mis-shapened cornea or keratoconus, and other reasons.
I am happy to offer a full range of options for corneal transplantation. I have been fortunate enough to perform over 1,000 transplantation procedures over the years and am happy to be able to offer my patients a procedure with which I have had excellent success.
Types of corneal transplantation
The traditional form of corneal transplantation is called PKP or penetrating keratoplasty. This has been around for many decades in general. I have made many subtle modifications in my technique which I believe has allowed me to refine the process and limit the chances of complications and maximize the opportunity to achieve good vision. For example, I have very strict limitations on the type and age of donor tissue that I accept for corneal transplantation. I use a suturing process that encourages the cornea to take a round shape and selectively remove these sutures and use various incisions when necessary to minimize astigmatism. In cases where cataracts are concurrent, I typically prefer to do the cataract surgery subsequent to the the transplant in order to use lens implantation as a further tool minimizing the amount of eyeglass prescription afterwards. Thereby, I attempt to do whatever I can to not only have an optically clear graft, but also try to minimize the amount of eyeglass prescription that is necessary afterwards to achieve best corrected vision. When it comes to surgical technique, I have participated in developing a method of replacing the cornea which does not ever allow the eye to be fully exposed to open air and zero pressure, minimizing the chance of some of the more ominous intraoperative complications such as hemorrhage.
I am also proud to be able to offer my patients some of the newest variations of the corneal transplantation surgery. One of these is the DSEK procedure. DSEK is a partial corneal transplantation of the back layer of the cornea. It is only appropriate for people who have only an unhealthy posterior cornea, so not everyone is a candidate. It basically involves stripping away only the back layer of the cornea and replacing it with a small posterior portion of the corneal graft that is inserted through a tiny opening. The advantages of this approach are a small incision size and rapid return to physical activity. Rehabilitation of vision may also be quite rapid, sometimes on the order of several weeks instead of six months. The disadvantage of this type of procedure is that occasionally more than one follow-up procedure is necessary. The graft must be floated up on an air bubble and made to adhere the underside of the cornea. In some instances, the graft can be traumatized by this process and/or may slip off. Subsequent procedures may be needed to cause the transplant tissue to re-adhere, or replacement of the transplant may be needed. Nevertheless, this is still an excellent option for some patients
I am also proud to offer the DALK procedure (deep anterior lamellar keratoplasty) which is a partial transplantation of the anterior cornea, which may also be appropriate for some patients in certain situations where there is a disruption of only the front part of the cornea. This is especially useful where the patient has a limited ability to cooperate and avoid rubbing their eye.
As with other aspects of opthalmologic care, I firmly believe is it important to match the type of corneal transplantation procedure to the individual needs of the patient and the specifics of the particular eye being worked on.
I am happy to be able to offer a variety of methods to best suit the individual needs and specifics of a given patient and to help them choose the best pathway for them to optimal visual recovery and good sight.