"New techniques for corneal transplantation are associated with improved safety and more rapid visual recovery along with equal or, in some cases, better visual results," says Anthony Aldave, MD, director of the Cornea Service at UCLA’s Jules Stein Eye Institute. Corneal transplants are designed to remove and replace only the affected layer of the cornea. For people whose vision is affected by swelling in the cornea’s innermost layer, the Descemet stripping endothelial keratoplasty (DSEK), which involves peeling off the diseased inner layer and replacing it with the innermost layer from a donor cornea, avoids the astigmatism (irregular shape of the cornea, resulting in blurred vision) commonly associated with full-thickness corneal transplantation. "Visual recovery is also more rapid than with a full-thickness transplant," Dr. Aldave says.
By contrast, the deep anterior lamellar keratoplasty (DALK) involves replacing everything but the cornea’s inner layer. The primary advantage of this procedure, for people with corneal scarring or keratoconus but with a healthy endothelium (inner layer), is that it eliminates the risk of rejection and failure of the endothelial cells that are critical to keeping the cornea clear. As the person retains his or her own corneal endothelium, the donor tissue does not need to have a healthy endothelium, and thus the requirements for the donor cornea are less stringent.
Another approach to corneal transplantation uses a femtosecond laser -- the same technology employed for making flaps in LASIK surgery -- to produce incisions in the cornea that enable the doctor to exercise far more precision in what is removed, so that the transplanted tissue fits into the cornea like interlocking pieces of a puzzle. As with the DSEK, this provides the potential to dramatically decrease postoperative astigmatism because of the precision of the laser, and it strengthens the wound site so that it is more resistant to traumatic opening in the event of eye injury following surgery.
Some people with diseased corneas who are not candidates for transplantation using donor tissue may be candidates for an artificial-cornea transplant. Indeed, corneal transplant surgery can be customized for the individual.
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