Cornea-Sparing Transplants

 When the critical inner cell layer of the cornea stops working, the cornea becomes cloudy. Francis W. Price, Jr., M.D., Medical Director of the Cornea Research Foundation, is now pioneering a new cornea transplant technique that replaces only the damaged cell layer instead of replacing the entire thickness of the cornea. With this new technique, known as (DSEK) Descemet’s Stripping Endothelial Keratoplasty, and (DSAEK) Descemet’s Stripping
Automated Endothelial Keratoplastythe cornea heals much faster and stronger and patient’s visual recovery is better.

 New sentence should read, "Dr. Price has described the evolution of the cornea-sparing transplant techniques in Current Opinion, Journal of Refractive Surgery and Ophthalmology and enumerated the many advantages of DSEK compared with standard full-thickness grafts, or an earlier cornea-sparing technique known as DLEK (deep lamellar endothelial keratoplasty).  To read Dr. Price's articles and abstracts click here.

SUTURELESS CORNEA TRANSPLANTS WITH RAPID VISUAL RECOVERY: A DREAM COME TRUE

(left)-Temporary air bubble holding posterior graft donor tissue in place eliminating the need for sutures1.

Recent advances have made DSEK Dr. Price’s preferred method of treatment for Fuchs’ dystrophy and pseudophakic bullous keratopathy. In fact, he no longer recommends standard penetrating keratoplasty (PK) for endothelial dysfunction unless there is significant scarring in the stroma (middle layer of the cornea, see diagram below).

Posterior graft patients now routinely see 20/60 or better within 3 months of surgery and some 20/20.

Over the past several years, Dr. Price has performed 300 DSEK procedures. Before switching to the DSEK technique, he had performed over 900 DSEK procedures. DSEK patients now routinely achieve 20/50 or better vision within a month of surgery and some have achieved 20/25 vision within a week of surgery.

The basic DSEK technique consists of gently stripping off the diseased cell layer lining the inner surface of the cornea. A donor cornea is thinly sliced and the inner portion is folded in half for insertion through a small incision made in the white part of the eye. The doctor injects an air bubble into the eye to unfold the donor tissue and press it up into place. The natural pumping action of the donor endothelial cells quickly creates suction, which bonds the donor tissue to the recipient cornea.

Advantages of DSEK as compared to PKP are:

* The eye is left much stronger and more resistant to injury

* There is minimal change in refractive error because the patient's cornea is essentially intact

* Suture-related problems can be eliminated

* Visual recovery is significantly faster and better

  Endothelial keratoplasty with Descemet's stripping offers patients better visual recovery and a less protracted clinical course than standard PKP. It is a great alternative for younger, more active patients bothered by glare and blurring from guttata or for the elderly who dread the long and involved postoperative course of standard PKP.

The Cornea Research Foundation is tracking visual outcomes and offers an Advanced Cornea Course | click here | to train doctors from around the country in this new corneal transplant technique.

For more information about different types of cornea transplants please click on:
Cornea Updates.

References

1. Price FW. Corneal transplantation as a refractive surgical procedure. Journal of Refractive Surgery, 2005;21:216-217.

2. Price FW, Price MO. The quest for a refractive neutral cornea transplant: visual outcomes following Descemet's stripping with endothelial keratoplasty. Journal of Refractive Surgery, 2005; 21:339-345.

3. Price FW, Price MO. Descemet's stripping with endothelial keratoplasty (DSEK) in 200 eyes: Early challenges and techniques to enhance donor adherence. Journal of Cataract & Refractive Surgery, 2005, in press has been published.

4. Price FW, Price MO. Posterior keratoplasty to restore clarity to a failed penetrating graft. Cornea, 2005, in submission.