Cornea Cornea

The cornea is the outermost part of your eye and extremely important for clear vision and overall eye health. Your cornea is a transparent covering over the front part of the eye, much like the watch crystal on your watch. It covers your iris, pupil and anterior chamber. The cornea serves multiple purposes, forming a protective barrier against germs and dirt, filtering out ultraviolet rays and helping to refract light, an important component of vision.

A corneal transplant, also known as a corneal graft, or as a penetrating keratoplasty, involves the removal of the central portion (called a button) of the diseased cornea and replacing it with a donor button of cornea. Corneal grafts are performed on patients with damaged or scarred corneas that prevent acceptable vision. This may be due to corneal scarring from disease or trauma.

Corneal transplants are performed for a number of reasons, including:

  • Thin or cloudy cornea
  • Ulcers of the cornea
  • Hereditary corneal failure, such as Fuch's cornea
  • Cornea scarring, which can be caused by injury or infection
  • A cornea that bulges outward (Keratoconus)
  • Rejection after first corneal transplant
  • Complications of a previous eye surgery

Before undergoing corneal transplant surgery you will have a number of examinations. These include an eye exam during which your doctor will look for conditions that might cause you to have surgery complications. Your doctor will also take specific measurements of your eye to determine what size cornea you will need from a donor. You also receive treatment for any other eye problems you currently have, as eye problems that are unrelated such as inflammation or infection can reduce the chances of a successful corneal transplant.

DSEK - Descemet's Stripping Endothelial Keratoplasty (DSEK)

DSEK is a transplant procedure that corrects clouding while sparing the cornea. Using the DSEK technique, we will carefully strip away the diseased cell layer that lines the inner surface of the cornea. A donor cornea is then thinly sliced and the inner portion is folded in half for insertion through a small incision made in the white part of the eye. An air bubble is injected into the eye to unfold the donor tissue and set it in place. DSEK has several advantages over conventional transplant surgery.

No stitches are placed in the cornea. In clinical studies, this has resulted in significantly less astigmatism after surgery and faster recovery of vision.

In general, fewer follow-up exams are necessary because there are no corneal stitches to be removed. Ongoing studies are also examining whether corneal transplant rejection is less likely with DSEK than conventional transplants.

Like conventional corneal transplantation, DSEK surgery is covered by most major insurance carriers, including Medicare. DSEK is not appropriate for all patients with corneal disease.

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