A corneal transplant (keratoplasty) is a sight-saving surgery that allows patients with eyesight compromised by cornea damage to have their vision restored, in some cases, to 20/20. It is performed when the front and/or back layers of the cornea are abnormal. A corneal transplant can restore vision, reduce pain, and improve the appearance of a damaged or diseased cornea.
More than 40,000 corneal transplants are performed in the US every year, making it the second-most common transplant after blood donation and one of the most successful organ transplantations compared to other organ transplants.
The cornea is the clear, dome-shaped outer layer of the eye that is directly in front of the pupil and the iris (the colored part) and allows light to enter the eye. It provides approximately 65 to 75 percent of the focusing power of the eye and must remain clear for there to be good vision. A damaged cornea may result in glare or blurry vision. Cornea damage may be caused by an infection, a medical condition that leads to a thinning cornea, such as keratoconus; chronic swelling following cataract surgery; or by Fuchs Dystrophy, a genetic disorder that causes swelling.
While some form of the procedure has been performed since the late 1800s, corneal transplants did not become routine until the 1960s and since then, significant advancements have been made in technique, recovery, and resulting vision improvements.
Latest Advances in Corneal Transplants
New York Eye and Ear Infirmary of Mount Sinai (NYEE) is a leader in corneal transplants with more than 10 fellowship-trained cornea specialists performing this surgery. In recent years, they have had great success with the latest techniques, including Descemet's Membrane Endothelial Keratoplasty (DMEK) and Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK). By replacing only the damaged portion of the cornea with ultra-fine donor tissue, surgeons are able to produce much better patient outcomes than with other techniques.
Corneal transplants are performed on an outpatient basis under local anesthesia. The surgeon performs the surgery by making a small incision while looking at the eye through a microscope. The damaged corneal layer is replaced with donor tissue that has been thoroughly screened, processed, certified, and prepared by the eye bank. Advantages of DMEK and DSAEK over conventional full-thickness corneal transplantation include few sutures, faster visual recovery, and improved vision.
During the DMEK procedure, the surgeon carefully strips out the damaged Descemet's membrane and endothelium layer of the cornea and replaces it with micro thin tissue that, at 10 microns, is the thickness of a strand of hair. It is then secured with a gas bubble. The outpatient procedure typically lasts approximately 30-45 minutes. The procedure has been shown to have a low rejection rate (1 percent), faster recovery, faster and more significant improvement in vision, and less reliance on long-term use of eye drops that can cause immunosuppressive side effects. The clear vision of many patients is restored to 20/20 in as little as one to two months.
Patients who are not candidates for DMEK, including those with complex anterior segment anatomy, a previous history of retina detachment repair, or glaucoma surgeries, may benefit from Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK), which uses a thicker tissue that is secured with an air bubble. The expert surgeons at New York Eye and Ear Infirmary of Mount Sinai are able to apply both latest technologies of endothelial keratoplasties customized to patients’ individual anatomy and specific needs.