Keratoplasty

Corneal Transplant Surgery in Dayton, Springboro & Surrounding Areas

At CVP Physicians Dayton, our fellowship-trained corneal specialists Dr. Adam Cloud, Dr. David Denlinger and Dr. Jennifer Shade have extensive experience in performing cornea transplants. If you are seeking treatment for a cornea injury or condition, our team of eye care experts will explain your options and create a personalized treatment plan to preserve your eye health and improve your vision.

Who Gets Keratoplasty?

The primary recipients of cornea transplants are patients who require surgery to restore sight due to a cornea that is damaged by an eye condition or injury. Occasionally, keratoplasty may also be performed for cosmetic reasons to replace a cornea that is visibly clouded or scarred. Cornea surgery can treat a variety of eye diseases or injuries, including:

• Keratoconus (an eye disease that causes the cornea to bulge outward)
• Cornea scarring or other complications of previous infections or injuries
• Corneal disorders, including Fuchs’ dystrophy
• Corneal perforation or thinning
• Corneal edema or infection that does not respond to other treatments

Types of Keratoplasty

There are several types of corneal transplant surgery, which vary based on the technique used and the amount of the cornea which is removed. The cornea is made of several layers – beginning with the innermost endothelium, there is then the Descemet’s membrane, the stroma, the bowman’s membrane, and outermost epithelium. A traditional penetrating keratoplasty removes the full-thickness of the cornea, but some patients may have better results with a procedure that replaces only certain layers of the cornea. Your eye surgeon will discuss your options to determine the best method of keratoplasty for you.

Endothelial Keratoplasty (DSAEK, DSEK and DMEK)

An endothelial keratoplasty is a modern approach to cornea transplant, in which only the innermost layers of the cornea are replaced. There are three types of endothelial keratoplasty:

• The most common type of endothelial keratoplasty is called Descemet stripping endothelial keratoplasty (DSEK). In this procedure, approximately one third of the cornea, including the stroma, is replaced with donor tissue.
• A Descemet’s stripping and automated endothelial keratoplasty (DSAEK) is a similar procedure, with the addition of a specialized machine that creates automated incisions.
• A Descemet’s membrane endothelial keratoplasty (DMEK) replaces only the Descemet’s membrane and the endothelium. Since the stroma is not replaced, this procedure is not right for everyone, but it can reduce or eliminate the need for anti-rejection medications.¹

Deep Anterior Lamellar Keratoplasty (DALK)

Deep anterior lamellar keratoplasty, or DALK, is a procedure to remove the outer layers of the cornea. This procedure may be an option for patients with a healthy, well-functioning endothelium and Descemet’s membrane. The advanced lasers used in a DALK procedure can reduce postoperative scarring.

Penetrating Keratoplasty (PKP)

Penetrating keratoplasty, or PKP, is a traditional cornea transplant surgery in which the entire cornea is replaced with a donor cornea. A PKP procedure may be the best choice for patients who have certain eye diseases as well as those who have experienced rejection of a previous corneal graft.

What to Expect From Corneal Transplant Surgery

Preparing for Keratoplasty

Your eye doctor will conduct thorough examinations and discuss your treatment options with you prior to creating a treatment plan for cornea transplant surgery. Once it is determined that keratoplasty is right for you, you will be placed on a waiting list for a donor cornea. Healthy corneal tissues from deceased donors are typically widely available. Your surgeon will give you detailed preoperative instructions to follow leading up to your surgery date.

The Keratoplasty Procedure

Keratoplasty is usually an outpatient procedure performed with local anesthesia. General anesthesia is not typically used, but your eyes will be numbed and you will be given sedative medication to help you relax. The surgical technique used will depend on the type of keratoplasty you have, and your surgeon will explain the steps of the procedure prior to your surgery date.

¹ Price FW Jr, Price MO; Evolution of endothelial keratoplasty. Cornea. 2013 Nov32 Suppl 1:S28-32. doi: 10.1097/ICO.0b013e3182a0a307.
² Mayo Clinic. Cornea Transplant. Available: https://www.mayoclinic.org/tests-procedures/cornea-transplant/about/pac-20385285 Accessed June 9, 2020.