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Corneal Transplantation

corneal_exam

A corneal transplant is a surgical procedure to remove and replace a damaged or diseased cornea with healthy tissue from a deceased donor. It is performed when both the front and back layers of the cornea are abnormal. Over 46,000 people in the United States have corneal transplants each year. This sight-saving surgery requires patients and ophthalmologists to work closely together to insure its success.

Corneal transplant surgery is also called penetrating keratoplasty or corneal grafting. Your eye is the recipient eye because it receives the graft. The other person’s cornea is the donor cornea or donor tissue. An eye bank provides the donor tissue for corneal transplant surgery from deceased individuals who arranged for the donation prior to their death or whose families gave permission to use their cornea.

New York Eye and Ear Infirmary of Mount Sinai (NYEE) is one of the busiest corneal transplant centers in the country, with  over 10 fellowship-trained cornea specialists performing transplants. Corneal transplants are performed on an outpatient basis under local anesthesia. The surgeon performs the surgery while looking at the eye through a microscope. A cookie cutter-like knife called a trephine is used to cut and remove a circular piece from the recipient’s scarred cornea. A similar knife is used to cut and remove a piece from the donor cornea, which  replaces the recipient’s cornea. It is sewn into place with sutures that are finer in diameter than a human hair.

The procedure is widely used to restore vision to people whose corneas have been compromised by conditions like keratoconus, post-cataract surgery edema, corneal scarring from infection or injury, and corneal ulcers. Though the vast majority of corneal transplants are successful, risks do exist, including rejection of the donor’s cornea.

Latest advances in corneal transplants

In some situations, your surgeon may transplant only part of the corneal thickness. When  the front part is transplanted, it is called anterior lamellar keratoplasty. When the back part is transplanted, it is called endothelial keratoplasty. Some well-known variations of endothelial keratoplasty include DSEK (Descemet’s stripping endothelial keratoplasty) and DMEK (Descemet’s membrane endothelial keratoplasty). DSEK involves removing the damaged endothelial cells and Descemet’s membrane and replacing them with a partial thickness graft that includes a small amount of cornea stroma, donor endothelium and Descemet membrane. DMEK transplants only the donor’s endothelium and Descemet membrane. Both surgeries are performed through a small incision, requiring that the graft be folded or rolled to gain entry to  the eye.

Advantages of DSEK and DMEK over conventional transplant surgery include a small incision with few sutures, faster visual recovery than with full-thickness corneal transplantation, and minimal change in astigmatism or post-operative refraction. Both DSAEK and DMEK have been shown to improve visual acuity, donor cornea graft survival, and endothelial cell loss. Two of our senior ophthalmologists, Drs. David Ritterband and John Seedor, were among the earliest adapters of endothelial keratoplasty nearly 10 years ago, and today perform more than 400 transplants annually on patients with damaged or diseased corneas. Many of these patients are referred to NYEE from ophthalmologists throughout the Northeast.

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