Cornea Transplant

A corneal transplant involves surgically replacing a diseased or scarred cornea with a new one. When the cornea becomes cloudy, light cannot penetrate the eye to reach the light-sensitive retina. Poor vision or blindness may result.

In corneal transplant surgery, Drs.Schultze and Eden remove the central portion of the cloudy cornea and replace it with a clear cornea, usually donated through an eye bank. They place the new cornea in the opening and secure it in place with a very fine suture. The suture stays in for months or even years until the eye heals properly (removing this fine suture is quite simple and can easily be done in office). For several months following surgery, eye drops are used to promote healing.

Corneal transplants are very common in the United States; about 40,000 are performed each year. Success rates have greatly improved with incorporation of technology and advanced surgical techniques.

In general, success rates of corneal transplantation are approximately 90% and the average longevity of surgery is 10 years. Depending on any pre-existing conditions, success rates can vary. Some patients maintain a clear cornea for over 20 years after surgery and some become cloudy within months. Surgery can be repeated if necessary.

Are there alternatives to a corneal transplant?

Phototherapeutic keratectomy (PTK) is one of the latest advances in eye care for the treatment of corneal dystrophies, corneal scars, and certain corneal infections. Only a short time ago, people with these disorders would most likely have needed a corneal transplant. By combining the precision of the excimer laser (This laser emits pulses of ultraviolet light--a laser beam--to etch away surface irregularities of corneal tissue.) with the control of a computer, doctors can vaporize microscopically thin layers of diseased corneal tissue and etch away the surface irregularities associated with many corneal dystrophies and scars. Surrounding areas suffer relatively little trauma. New tissue can then grow over the now-smooth surface. Recovery from the procedure takes a matter of days, rather than months as with a transplant. The return of vision can occur rapidly, especially if the cause of the problem is confined to the top layer of the cornea. Studies have shown close to an 85 percent success rate in corneal repair using PTK for well-selected patients.

The Standard Cornea Transplant Procedure

A human donor cornea is obtained from a tissue bank after being screened for suitability and infectious diseases. After administration of anesthesia, an eight millimeter central area of the diseased cornea is removed and the new cornea is stitched into place with very thin sutures.

After surgery, you will need to start taking eye drops to prevent infection and rejection. You will take them quite frequently at first, every two hours while awake and gradually tapered to one drop a day for the rest of your life.

Your vision will be blurry at first, because of the stitches and post-operative swelling. The stitches may be removed gradually over the next few months. Most people are able to return to work or school about a week after surgery.

During your recovery, it is vital that you take all medications as directed, keep your follow-up appointments and pay attention to your eye. Any change such as increased redness, discharge, sensitivity to light, pain, or blurring should be reported to the office right away. This could be an indication of transplant rejection. This can often be reversed if caught soon enough and treated promptly with anti-rejection eye drops.

Visual recovery from corneal transplant surgery takes about a year. Recipients will likely require glasses, contact lenses, and/or additional minor office procedures to improve the vision. Even after your cornea has healed, you'll need regular ophthalmology exams for the rest of your life.

EK (Endothelial Keratoplasty)

also known as DSAEK (Descemet Stripping Automated Endothelial Keratoplasty)

EK is a newer method of corneal transplantation. EK involves only replacing some of the posterior or inner layers of the cornea as compared to the standard corneal transplantation when the full thickness of the cornea is replaced. Patients with full thickness disease are not candidates for EK.

Cornea Consultants of Albany doctors have been pioneers in the field of endothelial keratoplasty. They were the first surgeons to perform the procedure in the state of New York in 2003 and have had great success. They are the recognized leaders in Northeastern New York in advanced techniques of corneal transplant surgery. They have presented their results at conferences around the country and the world.

Some of the advantages of the surgery as compared to standard corneal transplantation are:

• a smaller wound and fewer stitches are needed
  
• the eye heals faster and vision can return in 3-6 months compared to up to one (1) year
  
• Usually a contact lens is not necessary for visual rehabilitation
  
• the eye is less susceptible to injury and rupture
  
• one's glasses should be more similar to what they were prior to surgery with smaller changes in astigmatism, nearsightedness or farsightedness
  
• the incidence of stitches causing infection or irritation should be greatly reduced.

Some of the disadvantages of the surgery are:

• the surgery is relatively new
• it is not known if this method affects the success of the transplant or how long the effect will last
  
• difficulties could occur during surgery where the surgery would have to be converted to a standard corneal transplant.

DEEP ANTERIOR LAMELLAR KERATOPLASTY (DALK)

DALK is an additional newer method of corneal transplantation. It replaces only the superficial layers of the cornea. Candidates typically have keratoconus or other disease of the superficial layers of the cornea only. Success rates are approximately 50% due to the highly technical nature of this procedure. Fortunately, if the cornea does not divide optimally at the time of the procedure, a full-thickness keratoplasty remains an option to rehabilitate vision. Potential advantages to DALK include greater structural integrity of the eye and decreased chance of rejection.

Please personally discuss the risks, benefits and alternatives of any corneal surgery with our doctors at Cornea Consultants of Albany.

Artificial Cornea

An artificial cornea may be an option for patients who have repeatedly failed a transplanted human cornea. The synthetic material used in artificial corneas is rigid plastic.  Unfortunately, the material does not bio-integrate so the keratoprosthesis device requires the indefinite use of several expensive eye drops and requires lifelong ophthalmologic eye care.

This device allows those with untreatable conditions to maintain independence and mobility. While there is much work ahead, current research of artificial corneas is very promising. Drs. Schultze and Eden are constantly evaluating and testing new technologies that have potential of benefit for their corneal patients.

Sutured Intraocular Lens

In some patients after cataract surgery, their eye lacks the support to adequately place an intraocular implant. These types of patients have either had a history of cataract surgery, typically many years ago, and were left aphakic (without an implant), or have had IOL complications such as IOL dislocation requiring IOL exchange.

Drs. Schultze and Eden, in most cases, are able to suture an intraocular implant in place. The placement of this lens can often lead to positive visual results.

Intacs

Intacs are clear, arc-shaped plastic “stents” placed within the peripheral cornea.  Originally FDA approved to correct low amounts of near sightedness, they are currently used to improve the cornea shape of patients with keratoconus or and irregular cornea shape due to LASIK complications.  This indication gained FDA approval in 2004.

While some patients have experienced remarkable improvement in the shape of their cornea after this procedure, in general the majority experience an improvement in the tolerance of their contact lenses.  The effects do appear to last some significant period of time.

Doctors at Cornea Consultants of Albany were the first in Northeastern New York to perform Intacs.  We encourage you to personally discuss your candidacy with our doctors as well as your risks, benefits and alternatives to this procedure.

Pupilloplasty

Pupilloplasty is a surgical procedure on the iris to alter the shape or function of the pupil. It is usually performed to repair damage after trauma.  Pupilloplasty can render the pupil cosmetically more acceptable, and may improve glare or light sensitivity.

Doctors at Cornea Consultants of Albany are the only surgeons in Northeastern New York to have available very delicate instruments to actually tie and manipulate sutures within the eye thus minimizing surgical trauma and improving recovery time.

Stem Cell Transplant

Between the clear part of the eye (cornea) and the white part of the eye (sclera) is an area called the limbus, where stem cells are located? Limbal stem cells are "mother cells"; they help grow new corneal cells that are vital for clear vision. Severe damage to limbal stem cells, most often happening through inflammatory disease or chemical trauma, significantly impairs a person's vision.

During a stem cell transplant, limbal stem cells are taken from the patient’s healthy eye or the eye of close family member.  This procedure, if successful, will jumpstart the body’s production of corneal cells enabling improved vision.  Rejection is a common complication and requires oral medication under the supervision of a specialist.

Pterygium Surgery

A pterygium is a pinkish, triangular-shaped benign tissue growth on the cornea.  Pterygia are most often found in 20-40 year old patients from sunny climates. A pterygium is visible and many people want to have it removed for cosmetic reasons; however, surgery to remove a pterygium is usually not recommended unless it affects vision. If a pterygium is surgically removed, it may grow back, particularly if the patient is less than 40 years of age.

Recurrence rates are as high as 50% but newer techniques employed at Cornea Consultants of Albany such as conjunctival flaps, conjunctival transplants and/or amniotic membrane are all available to improve outcomes.

We encourage you to personally discuss your options with our doctors as well as your risks, benefits and alternatives to surgery.

Cornea Biopsy

A cornea biopsy is the removal and testing of a very small sample of corneal tissue. It is most often used when there has been a lack of response to treatment, cultures have been negative on more than one occasion or the clinical picture continues to strongly suggest an infectious or inflammatory process. In a cooperative patient, corneal biopsy will be performed while at the slit-lamp or operating microscope. Using topical anesthesia, a small piece of corneal tissue is removed and sent to the laboratory for additional testing.