Cornea Transplant and Surgical Procedures

Ophthalmic Specialists of Michigan provide surgery for a range of corneal conditions.  These include cornea transplant procedures as well as other cornea treatment options.

Cornea Transplant Procedures

There are several types of cornea transplants. Each type has certain advantages and disadvantages, strengths and weaknesses, when compared to the others. If you may need a cornea transplant, your doctor will advise you on the pros and cons of each suitable option when considering your individual condition and circumstances. The 3 most commonly performed types of cornea transplants are:

Penetrating Keratoplasty

Penetrating Keratoplasty (PK) is a cornea transplant surgery that involves replacing the full thickness of the cornea with a donor cornea donated by someone who has passed away. It is an outpatient procedure that is performed in an operating room using a special surgical microscope. The central portion of the cornea is removed and replaced with clear, healthy donor tissue that is held in place by many tiny sutures.

Complications

As with any surgical procedure, complications can occur. Some complications that we monitor include postoperative glaucoma, infection, retinal swelling or detachment and cataract. Graft rejection, which occurs when a patient’s own immune system reacts against transplanted tissue from a donor, is another complication that can occur after corneal transplantation. Symptoms of graft rejection include redness, light sensitivity, blurred vision and a swollen corneal tissue. This is a serious concern, but in most cases, the graft rejection can be reversed with aggressive steroid treatment.

Recovery

The recovery of the best possible vision after a corneal transplant can take up to a year or longer. During your recovery, you will use eye drops daily to help prevent infection and rejection. On average, 8-12 follow-up visits will be required during the first year and these are critical for a successful outcome. Most patients who have had PK will need to wear glasses or contact lenses for ideal vision.

Descemet Stripping Automated Endothelial Keratoplasty (DSAEK)

DSAEK is a cornea transplant surgery that involves replacing the partial thickness of the cornea. In this procedure, the inner layer of the cornea including the endothelium is replaced with cornea tissue from a donor. A small incision is made to gain access to the inner layer and the damaged endothelial tissue is then removed and replaced with the new donor tissue. A few tiny sutures are used to close the wound, then the eye is filled with air which holds the new graft in place while it heals itself. In order for the air to work properly, the patient will need to spend the first 12-24 hours after surgery lying flat on their back. This is an outpatient procedure that is performed in an operating room using a special surgical microscope.

Complications

As with any surgical procedure, complications can occur. With DSAEK, there is a small chance of the donor tissue detaching within the first few days or weeks after surgery. If this were to occur, your doctor will likely have to perform a minor procedure to reattach the graft. In addition, as with any cornea transplant procedure, there is a risk of graft rejection, which occurs when a patient’s own immune system reacts against transplanted tissue. Symptoms of graft rejection include redness, light sensitivity, blurred vision and a swollen corneal tissue. This is a serious concern, but in most cases, the graft rejection can be reversed with aggressive steroid treatment.

Recovery

Recovery from a DSAEK procedure generally takes 3-4 months. The vision is usually quite poor, even worse than before surgery, for the first few weeks and then will gradually clear over several more weeks. Following surgery, you will use eye drops daily to help prevent infection and rejection. Several follow-up visits will be required and are critical for successful results from your transplant.

Descemet Membrane Endothelial Keratoplasty (DMEK)

DMEK is a cornea transplant surgery that involves replacing the partial thickness of the cornea. In this procedure, the critical inner layer of the cornea, the endothelium, is replaced with donated cornea tissue. The donated cornea in DMEK is even thinner than that used in DSAEK. A small incision is made to gain access to the inner layer and the damaged endothelial tissue is then removed and replaced with the new donor tissue. A few tiny sutures are used to close the wound, then the eye is filled with air which holds the new graft in place while it heals itself. For the air to work properly, the patient will need to spend the first 12-24 hours after surgery lying flat on their back. This is an outpatient procedure that is performed in an operating room using a special surgical microscope.

Complications

As with any surgical procedure, complications can occur. With DMEK, there is a small chance of the donor tissue detaching within the first few days or weeks after surgery. If this were to occur, your doctor will likely have to perform a minor procedure to reattach the graft. In addition, as with any cornea transplant procedure, there is a risk of graft rejection, which occurs when a patient’s own immune system reacts against transplanted tissue. Symptoms of graft rejection include redness, light sensitivity, blurred vision and a swollen corneal tissue. This is a serious concern, but in most cases, the graft rejection can be reversed with aggressive steroid treatment.

Recovery

Recovery after DMEK procedure generally takes several weeks to several months. Following surgery, you will use eye drops daily to help prevent infection and rejection. Several follow-up visits will be required and are critical for successful results from your transplant.

Other Cornea Procedures

Pterygium Removal

While most pterygia do not require surgical removal, it may be recommended for those that cause chronic discomfort or that affect one’s vision. This procedure is performed in the operating room as an outpatient procedure. Your doctor will remove the growth along with some of the surrounding tissue and then replace it with a graft of associated membrane tissue to prevent a recurrence of pterygium growth.

Complications

As with any surgical procedure, complications can occur. Poor wound healing, excessive scarring, infection and inflammation are possible after surgery. With pterygium removal, there is also a risk of having a recurrent growth of it. If this occurs, your doctor will observe the growth and if it becomes extensive, they may recommend another surgical procedure to remove it.

Recovery

Most patients can return to work after pterygium surgery within a few days. However, a recovery generally takes 4-6 weeks. Your doctor will discuss with you the aftercare instructions and follow up visits.

Corneal Crosslinking

What is Corneal Cross-Linking?

Corneal Cross-LinkingCorneal Cross-linking, which is also sometimes referred to as Corneal Collagen Cross-linking, is a minimally invasive outpatient procedure that is done in the doctor's office. This procedure is used to strengthen the cornea to prevent further worsening in a patient whose keratoconus is progressing. It is also used for patients that have corneal ectasia following refractive surgery. In these conditions, the proteins (collagen) in the cornea are structurally weakened, often leading to progressive distortion and thinning of the cornea and more and more trouble with achieving good vision. This cross-linking procedure strengthens and stabilizes the cornea by using special vitamin eyedrops called riboflavin (vitamin B2) and applying ultraviolet light (UV).

  • It creates new corneal collagen cross-links
  • It results in shortening and thickening of the collagen fibrils
  • It leads to stiffening of the cornea

Riboflavin is a vitamin (vitamin B2) that is important for body growth, producing red blood cells and helps to release energy from carbohydrates.  This vitamin is found in foods like dairy products, eggs, green leafy vegetables, lean meats, legumes and nuts.  Breads and cereals are often fortified with riboflavin. These vitamin eye drops used in corneal cross-linking function as a photoenhancer that enables the cross-linking to occur.

Ultraviolet A (UVA) is one of the three types of invisible light rays given off by the sun and is the weakest of the three.  After your eye has been soaked with the vitamin eye drops, a UV light source is applied to irradiate the cornea.  This process of cross-linking strengthens the cornea by increasing the number of cross-links in the collagen.

Complications

As with any surgical procedure, complications can occur. Some of these risks include infection, inflammation, scarring, swelling of the cornea, and blurred or hazy vision. If you are a candidate for this procedure, your doctor will discuss the risks and complications with you in detail.

Recovery

After the collagen cross-linking procedure, your doctor will place a special contact lens in your eye to protect it, to help it to heal and to reduce the pain that is frequently present in the first few days. In addition, you will be prescribed antibiotic eye drops, steroid eye drops, and lubricating eye drops. Your vision may be blurry at first but will improve as your cornea heals. Most patients are doing well within 5-10 days, but the cornea usually takes 1-2 months to heal completely.

Is Cross-Linking Right for Me?

Patients that have been diagnosed with progressive keratoconus or corneal ectasia following refractive surgery and are over the age of 14, should ask their doctor about corneal cross-linking.

Ophthalmic Specialists of Michigan is proud to offer patients the first and only FDA approved corneal cross-linking treatment for progressive keratoconus.  To learn more about whether you're a candidate, schedule an appointment with an OSM cornea specialist today by calling 1-800-237-EYES (3937).

Phototherapeutic Keratectomy (PTK)

Phototherapeutic Keratectomy is a surgical procedure that uses a laser to treat corneal diseases that affect the surface or superficial layers of the cornea. Conditions that may benefit include: certain corneal dystrophies, scarring of the cornea, keratoconus and recurrent corneal erosions. This is an outpatient procedure that is performed in a special laser room.

Complications

As with any surgical procedure, complications can occur. These risks include: infections, inflammation and corneal haze and scarring.

Recovery

Following the PTK procedure, your doctor will place a special contact lens in your eye to protect it, to help it to heal and to reduce the pain that is frequently present in the first few days. In addition, you will be prescribed antibiotic eye drops, steroid eye drops, and lubricating eye drops. Your vision may be blurry at first but will improve as your cornea heals. This usually takes several weeks to heal.

*Every patient is unique and therefore, the descriptions above may not apply to every individual situation. Your doctor will provide a full evaluation and discuss the best treatment options and plan for your conditions and circumstances.