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. UCLAHEALTH.ORG (continued from cover) 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 1-800-UCLA-888 (1-800-825-2888) 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