Corneal Transplants

The cornea is the clear, outer layer of the eye. A corneal abrasion is simply a scratch in the epithelium (skin), or the thin, outer layer of the cornea. Abrasions usually heal in a short time period, sometimes within hours. Deeper or larger scratches may take up to a week. The cornea has a tremendous number of nerve endings, which makes any damage to the cornea and corneal abrasions very painful.

Corneal Abrasion Symptoms

• History of a recent eye trauma
• Watery eyes
• Acute pain
• Sensitivity to light
• Blurry vision
• The feeling that there’s something in your eye
• Twitching eyelid

Treating Corneal Abrasions

Your doctor may apply topical anesthesia to help relieve the pain. Usually, a tight patch will be placed over the eye and if the abrasion is small, the epithelium should heal overnight. If the abrasion is large, it may take a few days and your doctor may prescribe antibiotics to help prevent infections. It is important that you do not rub your eye, especially during the healing process.

A corneal transplant, or keratoplasty, is a procedure to replace part of a damaged cornea with donor tissue. A cornea transplant can restore vision loss caused by Keratoconus, Fuch’s dystrophy, eye surgery complications, corneal ulcers, scarring, or infection.

The Nielsen Eye Center is proud to offer two advanced corneal transplant procedures, DSAEK and DMEK, to residents of the Greater Boston area, Quincy, Norwood Massachusetts, and the south shore.. DSAEK and DMEK are faster, less invasive, and result in fewer complications than a traditional cornea transplant.

What is a Traditional Cornea Transplant?

The medical term for a traditional corneal transplant, also known as a full thickness cornea transplant, is a penetrating keratoplasty (PKP). The PKP procedure replaces all five layers of the cornea with donor tissue.

The goal of a full cornea transplant is to improve vision that is damaged as a result of corneal disease. However, due to the invasiveness of the procedure and the amount of tissue affected, traditional corneal transplants have longer recovery time and a higher risk of complications compared to newer procedures like DSAEK and DMEK.

What is DSAEK?

DSAEK stands for Descemet’s Stripping Automated Endothelial Keratoplasty — it is one of the most advanced procedures for correcting corneal damage.

Traditional corneal transplants can cause discomfort, many sutures, and many visual complications. DSAEK decreases these problems by using donor corneal tissue to replace the two innermost layers of the cornea (endothelium and Descemet’s membrane), leaving the surface of the eye intact.

This changes what was once a very invasive procedure, into a quicker one with fewer complications. Since less tissue is affected, the incidence of corneal rejection is virtually eliminated, and patients often see better and sooner than with the traditional corneal transplant method.

What is DMEK?

DMEK, or Descemet Membrane Endothelial Keratoplasty, is very similar to DSAEK, with one exception — the donor transplant does not include any tissue from the stroma layer of the cornea. Instead, the transplant is composed entirely of healthy donor cells from the endothelium, the innermost layer of the cornea. This results in a smaller, thinner layer of donor tissue for transplantation.

The biggest advantage of DMEK is that it involves the least amount of change to the patient’s natural cornea, as the size of the transplant is less than 1/5 the thickness of a human hair. DMEK can be more challenging to perform than DSAEK because of the fragility and size of the donor tissue. DMEK is also a newer procedure than DSAEK, so it is not as widely available.

What Happens During DSAEK/DMEK?

Both procedures are performed in an outpatient surgical center where patients will be mildly sedated, and the eyes will be numbed with drops. The doctor makes a small incision through which he or she prepares and removes the innermost layers of the cornea. Through this same small incision, the doctor inserts the donor corneal tissue.

An air bubble is then created to correctly place and maintain the position of the transplant. The patient usually stays laying down for 10-15 minutes to ensure the donor cornea stays in place. Depending on the state of the corneal tissue after the procedure, the small incision will either be closed with a suture or two, or it will be left to heal on its own.

What Happens After DSAEK/DMEK?

The patient goes home after the procedure but is restricted to lying in bed with his/her face towards the ceiling for the rest of the day. Antibiotic and steroid eye drops are prescribed to reduce inflammation. Post-op exams and follow-up visits are scheduled for the first few days after the procedure to monitor healing and ensure there are no complications.

Benefits of DSAEK/DMEK

Compared with a traditional full thickness cornea transplant, DSAEK and DMEK offer these advantages:

• Low risk of corneal implant rejection
• Low risk of long-term reliance on topical steroids
• Visual recovery is much faster
• Minimal restrictions on activities such as exercise or driving
• Minimal change to eyeglasses prescription

For more information on DSAEK and DMEK corneal transplants at The Nielsen Eye Center, contact the office nearest you. Our practice is proud to serve the Greater Boston communities of Quincy, Weymouth, Norwood, and Norwell Massachusetts.