Surgery Offers Less Risk, Rapid Vision Recovery

A large percentage of corneal transplant patients may face fewer risks and have their vision restored more quickly, thanks to a new less invasive procedure being performed by Ira Udell, MD, vice chairman of the Department of Ophthalmology of Long Island Jewish (LIJ) Medical Center.

Dr. Udell examines Mrs. Newton's right eye, after she received the new corneal transplant procedure.

"The surgical technique is one of the most important breakthroughs in modern corneal transplantation in 60 years," said Dr. Udell, who also is chief of the hospital's Division of Cornea/Anterior Segment. "The new approach requires minimal suturing and provides patients with less discomfort, more rapid visual restoration and a reduced risk of sight-threatening complications." The procedure, known as DSAEK, stands for Descemet's Stripping Automated Endothelial Keraplasty. The delicate surgery allows the abnormal back layer of the cornea, Descemet's membrane, to be stripped away.

Using highly specialized automated instrumentation, the back surface of a corneal transplant donor is prepared and through a small incision, placed into the front of the eye. It is secured with a large air bubble to properly position and maintain the delicate transplanted tissue. Within minutes of transplantation, the endothelium, or back surface cells, which pump fluid from the cornea, start to function in the new host environment. The incision is closed with three small sutures, leaving the surface of the cornea free of sutures. Most patients often experience visual improvement within days or weeks after the procedure.

With a conventional corneal transplant, the full thickness of the patient's cornea is completely removed, and a full thickness new donor cornea is sutured around the circumference of the cornea. These sutures can remain in the eye for more than a year and often cause the cornea to take on an irregular shape during the healing process that is difficult to correct with eyeglasses. While the success rate of corneal transplants for swollen corneas is in the range of 90 percent, according to Dr. Udell, the post-operative results are difficult to predict. "It may take take up to one year or more for a patient to achieve full potential of vision after surgery," he said.

On May 3, Dr. Udell performed his first DSAEK corneal transplant on Leona Newton, 89, of Hicksville, NY. Mrs. Newton, who four years ago had a conventional cornea transplant in her left eye for corneal swelling, had the new surgical technique done on her right eye. "From the moment Dr. Udell took my eye patch off, I could see," said Mrs. Newton. "It was just amazing. I was reading two days after the surgery." Mrs. Newton said she expected some cloudiness because of the long healing time she had with her left eye. Although Mrs. Newton continued with her hobbies while she was waiting for the second corneal transplant, she is grateful for the clear vision in her right eye. She is an avid landscape painter, reader, gardener and seamstress. Mrs. Newton is a mother of five, has 12 grandchildren and 17 great grandchildren. "I love to travel to visit my family," she said. "I have no pain, no problems, no nothing. It's unbelievable."

The cornea is the clear window at the front of the eye that bends and helps focus light onto the back of the eye or retina. In order for vision to be clear, the cornea must be clear. There are multiple causes that can lead the cornea to become opaque or cloudy, preventing light from passing through it clearly. While corneal disease can occur anywhere on the cornea, the DSAEK procedure only treats conditions that occur on the back of the cornea. Each year, 30,000 corneal transplants are performed in the United States. As the DSAEK technique evolves, patients who are carefully selected and meet the criteria for the procedure may have better outcomes than the conventional surgical approach.

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