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Corneal
C OV E R S T ORY
Newer Techniques for
Corneal Transplantation
Expand Patient Options
STORY HIGHLIGHTS
Advances in techniques are improving
outcomes and expanding indications
for corneal transplantation.
Artificial corneal transplantation is
an option for patients who are not
candidates for traditional corneal
transplantation or who have
experienced corneal-transplant failure.
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The traditional surgery, known as full-thickness
corneal transplantation or penetrating
keratoplasty, uses a round, bladed “cookie
cutter” called a trephine to make an incision
through all layers of the patient’s cornea, restoring
clarity by replacing the central cornea with one
from a donor eye. For patients who develop
corneal swelling and decreased vision from
dysfunction of only the corneal endothelial cells
— the indication for approximately 50 percent of
the corneal transplants performed domestically
each year, DSEK in now the procedure of choice,
Dr. Aldave says.
The procedure involves peeling off the diseased
corneal endothelial cells and the Descemet
membrane, to which they are attached, and
replacing it with endothelial cells from a donor
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cornea, along with a thin amount of the overlying
donor corneal tissue. The new inner layer is
placed inside the eye and positioned using an air
bubble so that the surface of the patient’s cornea
isn’t touched. The incision is then closed with two
sutures and most of the air bubble is removed
10 minutes after being placed. In addition to a
faster visual recovery, many of the complications
associated with full-thickness transplantation,
including suture-related infections and associated
irregular astigmatism, are eliminated.
Deep Anterior Lamellar Keratoplasty
A complement to DSEK is deep anterior lamellar
keratoplasty (DALK), a selective transplant
procedure for patients with a corneal scar or
keratoconus, but who have normal corneal
endothelial cells. Rather than replacing the