Endothelial Keratoplasty

An endothelial keratoplasty is an alternative type of corneal transplant, a surgical procedure that removes the abnormal inner lining of the cornea, known as the endothelium, and replaces it with a donor cornea.

The cornea is the clear covering of the front of the eye which bends, or refracts, light rays as they enter the eye. If the cornea is not shaped properly or is somehow clouded, whether because of injury, infection or disease, visual acuity is compromised, and a corneal transplant may be recommended.

The three surgical methods of an endothelial keratoplasty include the following:

Descemet's stripping and automated endothelial keratoplasty, known as DSAEK
Descemet's stripping endothelial keratoplasty, known as DSEK
Descemet's membrane endothelial keratoplasty, known as DMEK

Benefits of an Endothelial Keratoplasty

An endothelial keratoplasty requires a much smaller incision than a regular cornea transplantation and results in fewer risks and a shorter recovery time. Recovery of vision is quicker with an endothelial keratoplasty and there is less of a restriction on activities. There is less of an issue with astigmatism with an endothelial keratoplasty and there are minimal or no suture problems.

Candidates for Endothelial Keratoplasty

Endothelial keratoplasty is commonly performed on patients with Fuchs' Dystrophy, which is an inherited eye disease that causes the cells of the endothelium to deteriorate, resulting in distorted vision and corneal swelling. As the condition progresses, vision will continue to worsen because damaged cells are unable to grow back.

Endothelial keratoplasty has also been performed on patients who have the following conditions:

Swelling of the cornea after cataract surgery
Clouding of the cornea
Graft failure from a previous cornea transplant
Keratoconus
Trauma

The Endothelial Keratoplasty Procedure

During the endothelial keratoplasty procedure, the surgeon will make an incision in the sclera, the white part of the eye. This incision allows the surgeon to access the cornea, and remove the damaged endothelial tissue using a microkeratome blade, the same instrument that is used during LASIK surgery. The donor tissue is then folded and implanted inside the eye.

After the donor tissue has been placed, it will either unfold on its own or be unfolded by the surgeon. An air bubble is injected to properly position the graft. This procedure is performed with a topical anesthetic to minimize any potential discomfort. The actual procedure takes up to 45 minutes to perform.

Recovery from Endothelial Keratoplasty Procedure

After the procedure, the patient will be moved to a recovery room and monitored before being allowed to go home. A prescription will be given for antibiotic and steroid eye drops, which are to be taken during the next few days to help with healing. Post-operatively, the patient will be required to lie down, face up, for the next 24 hours. A follow-up appointment will need to be scheduled.

Most patients notice improvements to their vision within the first 2 weeks after surgery, with results continuing to develop during the next 4 to 6 months. This is significantly faster than with the traditional corneal transplant procedure, which may take 6 to 12 months before effective results are achieved. Other existing eye conditions may slow or hinder the improvement of vision after the procedure.

Risks of the Endothelial Keratoplasty Procedure

While the procedure is considered safe for most patients that have cornea damage, there are certain risks involved with any type of surgical procedure, including:

Infection
Bleeding
Transplant rejection
Redness of the eyes
Sensitivity to light
Blurred vision
Pain