Endothelial Transplant

What is Corneal transplant?

Corneal transplant is a surgical procedure where the diseases cornea is replaced by a clear donor cornea.​

What are the types of corneal transplant?

There are various types of corneal transplant depending on the layers of corneal tissue that are replaced by the donor tissue.

The cornea has 5 layers of tissue.

1. Full thickness corneal transplant or Penetrating Keratoplasty (PKP): In this type of surgery the entire thickness of the cornea tissue or all the layers of the cornea are removed and replaced by a full thickness donor cornea or donor graft. This precure is performed for conditions where the entire cornea is affected Eg Advanced Keratoconus, Full thickness cornea scar.

2. DALK (Deep Lamellar Keratoplasty): The major bulk of the cornea or the anterior 90% of the cornea is replaced by similar thickness donor graft. The innermost layers of the cornea are left intact.

This is done in corneal diseases where only the outer bulk of the cornea is affected but the innetlayers of the cornea are healthy. Eg Keratoconus.

3. Endothelial Keratoplasty: In this procedure the bulk of the corneal tissue is left in place . Only the inner poorly functioning layers of the cornea are replaced by healthy donor tissue.

There are 2 types of Endothelial transplant procedures

DSEK and DMEK.

What is a DMEK surgery?

DMEK stands for Descemet's membrane Endothelial Keratoplasty.

DMEK is the most recent and advanced type of partial corneal transplant procedure..

It involves replacing the diseased back layer of the cornea with a healthy donor layer.

Only the poorly functioning layer of corneal tissue is replaced with exact anatomically equivalent healthy layer from donor corneal tissue.

Wal disease that have resulted from poorly functioning endothelial pump cells. While the traditional corneal transplant replaces a damaged cornea with a full thickness donor cornea, and DSEK replaces the diseased back layer with a partial thickness donor graft, the DMEK procedure is the purest form of corneal transplantation, replacing only the diseased cell layer with an exact anatomical replacement of just that layer with no added thickness or tissue. As such, the vision recovery is far more rapid, the vision quality superb, and the risk of rejection minimized. Without a doubt, when possible, DMEK is the best option for patients whose cornea is cloudy due to poorly functioning pump cells, such as seen in Fuchs Endothelial Dystrophy.

What are the advantages of DMEK?

• Rapid visual recovery

• Better vision

• Minimal risk of rejection compared to other types of transplant.

• Smaller wound so more stability of the eye structure

Your surgeon will discuss different options with you to help you choose a lens that is best suited for your lifestyle, visual needs and preferences.

What is DSEK ?

DSEK stands for Descemet's stripping endothelial keratoplasty. It is a partial thickness corneal transplant that involves replacing the diseased back layer of the cornea with a thin strip of healthy and functioning corneal tissue. DSEK was the predecessor of DMEK. The procedure has t similar advantages as DSEK.

Or tissue to be placed on the back surface of the cornea. The DSEK procedure is designed for patients who have clouded corneas as a result of endothelial dysfunction. The endothelium pumps fluid from the cornea to keep the tissue clear. If these cells are not working properly, the cornea will become cloudy and will swell. Instead of transplanting the full cornea, only the diseased pump cells will be replaced.

Unlike the full thickness Penetrating Keratoplasty (PK), DSEK uses a much smaller incision resulting in a more stable wound that is less likely to open with trauma. DSEK can also reduce the risk of complications such as hemorrhaging or rejection that could threaten your vision.

Who is a good candidate for DSEK or DMEK?

Patients with Fuchs dystrophy benefit from DSEK and DMEK.

Fuchs dystrophy is a condition where the back layer of the cornea called endothelium does not function properly. A healthy endothelium pumps out fluid from the cornea to keep it clear. When these cells don't work properly the cornea swells with excess fluid andn becomes cloudy. Patient notices blurriness in vision , more so in the morning.

In DSEK and DMEK only the diseases bacl layer of cornea is replaced by healthy dunctioning endothelial layer along with its scaffold. The rest of teh cornea which is healthy is not replaced. As the new and healthy endothelial cells start functioning the cornea starts clearing up and vision improves.