The cornea is like the windshield to the eye. However it is not plastic or glass, but rather, living tissue. One can think of the cornea like an onion in that it has several layers. The innermost layer is a pump layer called endothelium which is constantly pumping out excess water so that the cornea can remain clear. Once these pumps fail, either due to aging, previous eye surgeries or in diseases such as Fuch’s dystrophy, the cornea will become cloudy. As a result, vision may drop, the patient may experience excessive glare, and in severe cases, the eye may experience pain.
When the patient begins to have these symptoms, our board certified, fellowship trained corneal surgeons at the Northwell Health Department of Ophthalmology will begin to evaluate our patients for potential corneal surgery. Options for corneal transplantation include the following:
- Penetrating Keratoplasty
This is the traditional form of corneal transplantation which removes all layers of the cornea using a precise circular trephine and sewing in a new donor cornea. This is an outpatient procedure usually done under local anesthesia at Syosset Hospital. This form of transplant is reserved for patients who have had corneal scarring from trauma, keratoconus, or severe corneal edema which has remained untreated for many years. Because it requires so many sutures, visual recovery may take months to a year as our Long Island corneal surgeons selectively remove sutures to optimize vision over time. When the cornea is at its optimal shape, the patient may then receive a pair of glasses or sometimes contact lenses for their best quality vision.
Because penetrating keratoplasty is a full-thickness operation and requires longer visual rehabilitation, other options for patients who have Fuch’s dystrophy or corneal edema without scarring include the following:
- Descemet's stripping automated endothelial keratoplasty (DSAEK) or Descement’s membrane endothelial keratoplasty (DMEK)
Patients who have corneal swelling only due to damage or loss to their endothelial or pump layer are candidates for DSAEK or DMEK. DSAEK is a form of partial corneal transplantation which replaces the diseased pump layer with a disc of donor tissue of about 90-120 microns thick. Drs. Udell, Shih, Steiner, and Winokur are all fellowship trained corneal surgeons who perform DSAEK at Syosset Hospital in Long Island and Manhattan Eye, Ear and Throat Hospital(MEETH) in Manhattan.
For selective patients who have not had previous vitrectomy and who have Fuch’s dystrophy, DMEK may be performed to selectively ONLY replace Descemet’s membrane. This procedure is the latest advance in endothelial keratoplasty performed by Dr. Carolyn Shih and is an attempt to obtain even better vision at a faster pace than DSAEK patients. However, it may require more postoperative care than for those patients who undergo DSAEK. For both DSAEK and DMEK, the patient must lay supine on their back for a day or two unless eating or going to the bathroom in order for their new transplants to adhere and begin to clear.
For more information or to book a consultation, please call us: If you are on Long Island call (516) 470-2020. If you are in Manhattan, please call Dr. Schrier at (212) 702-7300 or Dr. Winokur at (212) 702-7620.