Descemet’s Stripping with Endothelial Keratoplasty (DSEK) a newer cornea transplant technique that replaces only the damaged cell layer instead of replacing the entire thickness of the cornea. With this technique cornea heals much faster and stronger and the patient’s visual recovery is better.
Because this technique leaves a smoother interface and significantly improves the visual results, it has become a preferred method for treatment for Fuchs’ Dystrophy and pseudophakic bullous keratopathy.
The DSEK procedure can overcome many of these problems associated with a standard corneal transplant. With a DSEK procedure only the abnormal inner lining of the cornea is removed. A thin, circular disc is then removed from the inner lining of a donor cornea. This is folded and place inside of the eye where an air bubble pushes it in place until it heals in an appropriate position. No sutures are required and the structure of the cornea remains intact, leading to a faster visual recovery and less astigmatism.
The DSEK procedure is done under local anesthesia and takes approximately 45 minutes. For the first 24 hours after surgery you will be asked to lie on your back with your face pointed directly to the ceiling for as much time as you can tolerate. This will help the graft stay in position as the air bubble holds it up into place on your cornea. You will be given several drops to use to prevent infection as well as to help the eye heal comfortably. After the first 48 hours there are minimal restrictions to your activities. The vision is usually better within one week. 80% of the healing has taken place by one month but the vision can continue to slowly improve over the next four to six months.
Penetrating Keratoplasty (PKP) involves replacing an eye’s scarred, diseased or damaged cornea with clear corneal donor tissue. This procedure can improve visual acuity as it is replacing the cloudy cornea with clear donor tissue.
PKP is suitable for those with for corneal decomposition, corneal dystrophies (other than keratoconus) including Fuch’s Dystrophy, and corneal trauma/corneal scarring.
The donor cornea is prepared to create the corneal “button.” The corneal button will become the transplanted cornea. The diseased, or scarred, cornea is then removed, creating a “bed” for the transplant cornea. Finally, the donor cornea is gently sewn into place with ultra-fine sutures (approx. one-third the thickness of human hair, or less). Stitches are typically removed at one year.
Postoperatively, patients should expect very gradual recovery of vision. In fact, the best vision may not be obtained for six to 12 months or more following surgery, even though vision may be improved from the first day after surgery in some cases.
In patients with keratoconus the cornea is cone shaped. The surface of the cornea is also irregular for those with keratoconus resulting in a distorted image being projected onto the brain. Because the cornea is irregular and cone shaped, glasses do not adequately correct the vision in patients with keratoconus since they cannot conform to the shape of the eye.
Patients with keratoconus see best with rigid contact lenses since these lenses provide a clear surface in front of the cornea allowing the light rays to be projected clearly to the retina. This is how most cases of keratoconus are treated. However, there are some excellent new surgical options for patients with keratoconus who cannot tolerate these lenses.
Many patients are initially unaware they have keratoconus and see their eye doctor because of increasing blur or progressive changes in their prescription. Keratoconus may occur in one eye only initially but most commonly affects both eyes with one eye being more severely affected than the other. Both males and females and all ethnicities are equally affected.
The treatment approach to keratoconus generally follows an orderly progression from glasses to contact lenses to corneal transplantation. Glasses are an effective means of correction mild keratoconus. As the cornea steepens and becomes more irregular, glasses are no longer capable of providing adequate visual improvement. Corneal transplant surgery is indicated when a patient cannot wear contact lenses for an acceptable period of time or when the vision, even with contacts, is unsatisfactory. A gas permeable contact lens is the most highly effective way to manage keratoconus and 90% of all cases can be managed this way indefinitely. The use of gas permeable contact lenses has been the mainstay of the optical management of keratoconus. These lenses, manufactured in a large variety of unique designs, provide a regular surface over the cornea to neutralize the distortion brought on by the irregular cornea. No one design is best for every type of keratoconus. Since each lens design has its own unique characteristics, the practitioner needs to carefully evaluate the needs of the individual and find the lens that offers the best combination of visual acuity, comfort and corneal health. Fitting contact lenses for keratoconic eyes is by no means simple. Numerous lenses are often fit, and it can take a great deal of time. If the cornea becomes too scarred or painful, a corneal transplant may be necessary.
Dry eye related discomfort is one of the most frequent complaints heard by eye doctors. The symptoms of dry eyes are varied and the list below is by no means all inclusive, however patients that suffer from dry eyes usually experience a number of the following symptoms.
- Blurred Vision
- Foreign body sensation
- Burning sensation
- Sandy/gritty sensation
Dry eye syndrome, often referred to as keratitis sicca or keratoconjunctivitis sicca, is caused by insufficient and/or poor quality tears. There are three main components to human tears. Most human tears are produced by the lacrimal gland. The oily component of tears is produced by the meibomian glands and the third component, the goblet cells, keeps all of the components mixed up. When one of the parts of this mixture becomes unbalanced, dry eye syndrome can occur. There are numerous reasons as to why these glands may not be doing their part.
Insufficient tear production and/or poor tear quality are the most common causes of dry eye syndrome. Inflammation of the lacrimal gland is the most common cause of insufficient tear volume. Meibomian gland dysfunction, inflammation of the glands at the eyelid margin, contributes to poor tear quality. Medications can also cause ocular dryness. Hormonal changes also contribute to insufficient and poor quality tears.
Treatment Options for Dry Eye Syndrome
Artificial tears containing active ingredients such as carboxymethylcellulose, hydroxypropyl methylcellulose, glycerin, castor oil, polyethyline glycol or polyvinyl alcohol are used in mild cases of dry eyes. Not all artificial tear brands work the same or work in all patients. More severe case require additional treatment. If you find yourself using your artificial tears three or more times a day you should use a preservative free tear. Most patients find that artificial tears do help, however the affect is only temporary, lasting only 10-15 minutes. Most of these patients will experience significant relief with punctal occlusion.
The puncta is the small opening found on the edge of the upper and lower eyelids next to the nose. Tears drain out of the eye through the puncta into the nose, this is why your nose runs when you cry. If you aren’t producing enough tears then you don’t want the tears that you are producing to be drained away. Punctal occlusion is painless and performed in the office, taking only a couple of minutes.