What is the Cornea?

The cornea is the front, dome-shaped, transparent part of the eye. The clarity and shape of the cornea are vital in their main role: focusing light onto the retina. There are a number of conditions that can affect the clarity and shape of the cornea and in turn the quality of vision. Some of these conditions include Keratoconus, Fuch’s endothelial dystrophy, scarring, and infections.

Corneal Transplantation

There have been many advancements in corneal transplantation. If a corneal transplant is needed in your condition, our surgeons at Coastal Vision will identify the specific layer of cornea affected, and replace only the involved layer, leaving the healthy layers untouched. This will lead to the least invasive procedure possible, faster vision recovery, and improved visual outcomes.

DMEK & DSEK

If the innermost layer of the cornea (the endothelium) becomes affected, the procedure of choice is a partial-thickness corneal transplant: DMEK (Descemet’s Membrane Endothelial Keratoplasty) or DSEK (Descemet’s Stripping Endothelial Keratoplasty). These two procedures will treat conditions like: Fuch’s Endothelial Corneal Dystrophy failed corneal transplants and corneal swelling from a variety of conditions.

DMEK (Descemet’s Membrane Endothelial Keratoplasty)

This is the most advanced type of endothelial corneal transplantation technique to remove the diseased inner layer of the cornea, and replace it with exactly was is removed (Descemet’s membrane and endothelium). The donor tissue is thinner compared to DSEK (Descemet’s Stripping Endothelial Keratoplasty), which will lead to faster visual recovery, improved vision outcomes, and minimized risk of transplant rejection.

DSEK (Descemet’s Stripping Endothelial Keratoplasty)

This procedure is similar to DMEK in that only the diseased innermost layer of the cornea is removed, however, a thicker partial-thickness donor cornea is placed on the back surface of the cornea. Although DMEK has replaced DSEK in many corneal conditions, there are still cases where DSEK is the procedure of choice. Our Cornea-trained surgeons will evaluate each specific case and create a personalized plan, aiming for the best quality of vision and long-term survival of each corneal transplantation.

What is the difference between DMEK and DSEK?

In DMEK, the transplanted partial-thickness donor cornea is thinner than that in DSEK. This leads to a decreased risk of donor rejection, improved quality of vision, and faster vision recovery.

DALK (Deep Anterior Lamellar Keratoplasty)

This type of corneal transplantation is used when the innermost layer of the cornea (the endothelium) is healthy, and only aims to replace the more superficial layers of the cornea. The two most common conditions where DALK is beneficial are advanced keratoconus and corneal scarring. By removing and replacing only the affected layer of the cornea, vision outcomes, risk of complications, and incidence of graft rejection are improved compared to a full-thickness corneal transplant.

PKP (Penetrating Keratoplasty)

This is the oldest type of corneal transplantation, where all layers of the cornea are removed and replaced with a donor cornea. Although this type of corneal transplantation has largely been replaced with more advanced partial-thickness types of transplantation, there are still conditions where all the layers of the cornea are affected, and full-thickness transplantation is warranted.