Cornea Center

Corneal Transplant Surgery

Following disease, infection, or injury, the cornea may become weakened, cloudy, or scarred, leading to decreased vision or discomfort. If medicines, contact lenses, or other treatments are ineffective in improving the symptoms, the damaged cornea can be replaced with a healthy cornea from a donor. At Peninsula Laser Eye Medical Group, we’re pleased to provide three different types of corneal transplants: Penetrating Keratoplasty, Descemet’s Stripping Endothelial Keratoplasty, and Deep Anterior Lamellar Keratoplasty. With these different options, Dr. Liu selects the best treatment for his patients to improve vision while minimizing risks.

Descemet’s Stripping Endothelial Keratoplasty (DSEK)

DSEK is specifically suited to treat the damaged inner layer of the cornea (endothelium), which includes patients with conditions such as Fuch’s dystrophy, bullous keratopathy, or failed prior corneal transplants. DSEK involves replacing only the most inner layer of the cornea rather than the entire thickness of the cornea. Because most of the patient’s own cornea remains intact, the results are a smoother corneal surface and faster healing compared to a full-thickness corneal transplant.

Historically, full-thickness corneal transplant surgery has not changed significantly in the last 30 years. A conventional corneal transplant requires long periods of healing, sometimes up to 12 months for patients to enjoy good and stable vision. The traditional corneal transplant procedure requires multiple sutures and a lengthy post-operative recovery period until one reaches their final glasses or contact lens prescription. Now, with the advent of DSEK, we are able to insert a partial thickness corneal transplant through a 4mm incision that typically requires only a single suture and several weeks for recovery of vision.

Benefits of DSEK

  • Stronger corneal integrity with less sutures
  • Smaller incision for faster recovery and rehabilitation
  • Reduced risk of corneal graft rejection

Penetrating Keratoplasty (PKP)

Although attempts at corneal transplantation were made 100 years ago, the first consistent successful transplants were completed in the 1950′s. The type of transplant performed replaced all the layers of the central cornea, which is a Penetrating Keratoplasty. The new cornea is held in place with sutures until it’s fully healed, which can take up to a year. A corneal transplant is the most successful of all tissue transplants: an estimated 40,000 operations are performed in the United States each year.

Donor Tissue

Corneal tissue for transplantation comes from an Eye Bank. The process begins when someone has been generous enough to donate his or her eyes following their death. The Eye Bank carefully screens the donor cornea to ensure it meets the National Eye Bank Association quality standards. The color of the donor eye is irrelevant, since only the clear cornea in the front of the patient’s eye is replaced and not the colored iris behind it. Similarly, tissue typing is not necessary because there are no blood vessels in the normal healthy cornea. When healthy tissue becomes available, the central Eye Banks enter the information into a nationwide computer network. The corneal tissue is then sent by airplane to the site where it is needed after careful selection and screening by your surgeon. The tissue can be stored for several days in a nutrient fluid before its use.

Deep Anterior Lamellar Keratoplasty (DALK)

Deep Anterior Lamellar Keratoplasty (DALK) can be thought of as the opposite of DSEK: it replaces the outer corneal layers while preserving only the most inner layer of the cornea. This procedure is most commonly performed to treat advanced cases of keratoconus when the patient is no longer able to tolerate or achieve adequate vision with contact lenses. By preserving the inner layer of the cornea, the risk of corneal graft rejection is lower than a full-thickness transplant, and it also provides a lower risk of surgery and lower risk of infection. Similar to a PKP, sutures are used to hold the graft in place and healing may take upwards to a year.

DALK may only be used for select patients. Because the most inner layer of the cornea is approximately 50 microns, in rare cases the procedure may need to be converted into a full-thickness corneal transplant.

Dr. Liu completed a cornea fellowship and is specially trained in corneal transplantation to offer these revolutionary procedures to patients throughout Northern California and the Bay Area.

If you think you may benefit from these procedures or know someone who may need a corneal transplant, please schedule a consultation today by calling (650) 961-2585 or schedule online now by clicking this link.

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