Corneal transplant has proven to be a good alternative for patients with corneal problems. The usual procedure performed is the penetrating keratoplasty or a full thickness corneal transplant. It has been successful and it has brought in positive results for patients. However, graft rejection continues to be a persistent problem. Fortunately, there have been advances in corneal transplant surgery that have registered better visual outcomes and potential longer graft survival. Here’s a look at some of them:
Anterior Lamellar Keratoplasty
Anterior lamellar keratoplasty or ALKP is a corneal transplant procedure wherein a partial thickness donor corneal graft is placed over the recipient’s corneal bed. This is a viable option for persons with diseases in the anterior cornea such as the following:
• Anterior scars.
• Anterior Dystrophies.
• Infectious Keratitis.
Please note it is not appropriate for Fuch’s Dystrophy, which is a posterior cornea disease.
Here are some benefits of ALKP:
• It is an extra ocular procedure.
• It produces less astigmatism.
• It has a lower risk of allograft rejection and graft failure compared to conventional penetrating keratoplasty.
Femtosecond Laser-Assisted Keratoplasty
The femtosecond laser-assisted keratoplasty is another option for a corneal transplant. It may be divided into the following categories:
Femtosecond Laser-Assisted Lamellar Keratoplasty
The femtosecond laser is a near-infrared laser that has been successfully used to create precise lamellar flaps in Laser Assisted In Situ Keratomileusis or LASIK eye surgery. Currently, the femtosecond laser can also be used for penetrating keratoplasty and lamellar keratoplasty.
During the femtosecond laser-assisted lamellar keratoplasty, the laser is focused on precise intrastromal locations with submicron accuracy. When combined with the tight spot placement, it will allow the creation of smoother stromal beds in lamellar dissections.
Femtosecond Laser-Assisted Penetrating Keratoplasty
When you undergo a corneal trephination, you will most likely have a classic vertically aligned wound edge that will require relatively tight sutures to ensure a tight seal. With the femtosecond laser, a wide range of corneal cuts can be created to allow your surgeon to create side cuts of different configurations in both the donor and recipient corneas. This procedure gives you the following benefits:
• Wound stability will be enhanced.
• Corneal irregularity and astigmatism will be reduced.
• Number of sutures and suture tension will be reduced that will allow earlier removal of the sutures.
Dohlman-Doane Keratoprosthesis (Boston Kpro)
There are certain severe cornea and ocular surface diseases like the Stevens-Johnson syndrome, ocular cicatricial pemphigoid or chemical burns that register a high risk of graft failure when the conventional keratoplasty procedure is performed.
Fortunately, the Dohlman-Doane keratoprosthesis (Boston Kpro) has been found effective in restoring vision in patients who have severe blinding corneal diseases and are at high risk for repeated failed corneal transplants. For these patients, further keratoplasty would prove to be futile.
With this procedure, a collar button shaped device with PMMA optic clamps within it a donor ring of corneal tissue.
The design and post-operative management of this procedure is being continuously modified and has shown the following positive results:
• Better clinical outcomes.
• Better graft retention.
• Reduced complications like infection and melting.
• Restores long-term vision.
If you are a candidate for corneal transplant, you should consult your specialist optometrist or corneal specialist to check if any of these options would be applicable to you. What is also important to realize is that a corneal transplant is best left as a last resort. To date a corneal transplant will mean that most patients will require glasses to see properly and up to 50% of cases will require contact lenses. Often the reason a corneal transplant was performed was to try and move on from a contact lens.
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