Corneal transplantation, also referred to as a “penetrating keratoplasty”, replaces the clear membrane which covers the surface of the eye. It is performed in an outpatient surgical setting at the hospital, typically under a local anesthetic with the eye completely numb. Corneal tissue for the operation is harvested from a donor shortly before their death. As with all transplants, there is a possibility of the body rejecting the donor corneal tissue, however, due to the reduced blood supply to the cornea this risk of graft rejection is low. Full visual recovery may take a long time with corneal transplant, sometimes in excess of a year. Most transplants result in significant astigmatism and therefore may require some type of contact lens following the surgery. Success rates are typically above 90% and many patients enjoy years of successful vision following the procedure.
DMEK vs DSEK
A newer alternative to traditional corneal transplantation is known as Endothelial Keratoplasty or EK. EK procedures require fewer stitches, provide for a stronger wound, have less chance of suture abscess or ulceration, and allow for much faster healing than more traditional corneal transplants. Oftentimes, this preferred technique is used to restore vision to patients when the inner cell layer of the cornea isn’t working correctly. This is often the case with Fuch’s Dystrophy, bullous keratopathy or other disorders of the cornea. Carolina Ophthalmology offers two types of Endothelial Keratoplasty: Descemet’s Membrane Endothelial Keratoplasty, or DMEK, and Descemet’s Stripping Endothelial Keratoplasty, or DSEK.
DSEK is the most common EK procedure. Patients that undergo DSEK have 20-30% of the back of the donor cornea implanted into their eye. Most patients achieve an average vision of 20/30; assuming they have no other eye issues. There is a risk of donor rejection with DSEK, but it is less than a traditional corneal transplant, at around 12%.
The newest option for endothelial keratoplasty is DMEK. This procedure implants extremely thin donor tissue that is thinner than a human hair into the patient’s eye. DMEK has been shown to provide a more rapid recovery than DSEK. The rejection rate is also much less (less than 1%). Additionally, DMEK typically provides better vision for patients over DSEK and traditional corneal transplants. EK procedures are limited to specific diagnoses and your surgeon will review and discuss which option for corneal transplantation is right for you.
