The cornea is the clear window at the front of the eye and graft surgery is usually required if the cornea becomes scarred or cloudy (this must not be confused with cataract, which is a clouding of the lens inside the eye).

Corneal graft surgery has been used successfully for over 50 years and modern techniques are continuously improving patient outcomes.

The most common conditions that require corneal grafts include keratoconus and Fuchs Corneal Endothelial Dystrophy. Although full thickness grafts are still often required, some patients benefit from partial thickness grafts (DSEK or DALK) or endothelium only grafts (DMEK).

Graft material needs to come from organ donors, but unlike other transplants corneal grafts usually only require eye drops to prevent rejection and these can often be ceased in the long term. Synthetic (plastic) corneal grafts such as the Boston Keratoprosthesis are only suitable for patients with severely damaged eyes in which a donor graft would not survive.

This is the traditional approach for corneal grafting and it is still arguably the best approach for most patients because it replaces all layers of the cornea. The new graft is stitched into place with extremely fine sutures. It is common for these sutures to require some adjustment after the initial surgery and they often stay in place for up to 2 years. Visual recovery is very slow and frequent appointments are required with the surgeon. It is difficult to get the corneal curvature exactly right so most patients still require glasses or a contact lens to obtain clear vision. Eye drops are usually required for a few years to prevent rejection.

90% Anterior Corneal Replacement (DALK)

This is mostly done in patients with moderate to advanced hump, but is also useful in patients with corneal scarring that is confined to the front of the cornea. Vision recovery can be very slow, but because the inner layer of the patient’s cornea is preserved, transplant rejection problems are less and postoperative eye drops can often stop within 1 year.

10% back corneal replacement (DSEK or DSAEK)

This is done when the inner layer of the cornea (endothelium) is damaged but the other 90% of the cornea is in perfect health. The most common cause of endothelial insufficiency is focal corneal endothelial dystrophy, but it can also occur after complex cataract surgery. DSEK can have a much faster recovery time than PK, as most patients are only able to drive safely after 1 or 2 months. Some patients recover more slowly, while others require a second or third operation to perform the transplant. Eye drops may be needed for a year or more to prevent graft rejection.

Corneal Endothelium Replacement (DMEK) Only

Just like DSAEK, DMEK is performed when the inner layer of the cornea (endothelium) is damaged but the other 90% of the cornea is in perfect health. DMEK can have an even faster recovery time than PK or DSEK, but this method is very delicate and relies on a very healthy transplant. Not all eyes are suitable for this type of transplant, and about 20 to 30 percent of patients need another procedure (re-transplant or bubble). Nevertheless, DMEK is the preferred technique for endothelial repair due to superior visual recovery and reduced graft rejection. After completing a DMEK surgery course in Sydney, Dr. Atanasiev was one of the few surgeons to offer the technique in Adelaide.

The cost of corneal transplantation

Most treatment budgets cover corneal transplant surgery completely. In the absence of private health insurance, the cost of the pocket can reach $ 6,000 due to the complexity of the surgery and the cost of the transplant and other specialized equipment required. An accurate quote should always be considered with your specific considerations.

Source:eyesurgeonssa.com.au

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