As mentioned above, in cases of Fuchs’ Dystrophy or other cases where the pump cells (endothelium) of the cornea is damaged, making the cornea swollen, a partial thickness transplant can be performed instead of the traditional full thickness translplant. DSAEK stands for Descemet Stripping Automated Endothelial Keratoplasty and is a sutureless technique in which the surgeon prepares the partial thickness transplant prior to inserting it into the hosts’ eye and was introduced to Fresno by Dr. Ghajar. It allows for very fast visual recovery after surgery with lower risk of rejection. Special positioning after surgery is needed due to the placement of air instead of sutures into the eye. This air dissolves by three days and the patient can resume normal activities within 1-2 weeks!
Keratoconus is a common disease where the cornea becomes thin, cone shaped and irregular leading to irregular astigmatism that cannot be corrected with eyeglasses. Usually this disease occurs in young adulthood though even young teens may develop the condition which is associated with allergies and rubbing of the eyes which can make the condition worse. The first step for visual rehabilition is to try rigid hard contacts that form like a window in front of the abnormal cornea, but often the cornea is so abnormal or scarred that a contact lens can not help and at this time a transplant is usually needed. In some cases Intac rings can be placed into the cornea to create a more flat shape and again allow for contact lens wear. Because the inside layer of the cornea is still healthy in keratoconus, one possible option over full thickness transplantation is DALK whereby only the outer layers of the cornea are transplanted, but this is a difficult surgery only possible in cases where the cornea is not severely thinned.
Many novel and less invasive treatment options have now become available for different corneal conditions which previously had to be fixed by corneal transplantation. One of these is advances in contact lens technology whereby a combination of hard and soft contact lenses can allow a patient with keratoconus to see better without having to resort to that option. Our optometrists at Eye Medical Center, like Dr. John Kinney who has over 40 years of experience, can help many patients regain their vision without transplantation! Other options like Intacs rings can also help delay corneal transplantation in keratoconus. Collagen cross linking with riboflavin can also help strengthen the cornea in keratoconus and you can discuss this option with Dr. Ghajar. Another area in which corneal transplantation can be avoided are in cases when the surface layers of the cornea are damaged or scarred; in a process known as phototherapeutic keratectomy (PTK) a cool laser is used to remove the scarred area and restore clarity & a more normal shape.