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Corneal transplantation, or keratoplasty, replaces the damaged cornea with a healthy one from a donor. It is a low-risk procedure. It is the most common type of transplant surgery and has the highest success rate.
During a corneal transplant, a circular incision is made in the cornea. A disc of tissue is removed and replaced with healthy tissue. Local or general anesthesia may be used. The entire procedure lasts only 30-90 minutes.
Corneal transplantation is an alternative treatment to INTACS prescription inserts and rigid gas-permeable contact lenses for patients with keratoconus. It can also be recommended for severe cases of dry eye.
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Corneal transplants may be recommended for patients with dry eye, keratoconus, or other infections, diseases or injuries affecting the cornea.
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DSAEK
DSAEK is the latest technique in corneal transplantation. Short for Descemet-stripping automated endothelial keratoplasty, DSAEK offers clear post-operative vision and short recovery time to patients in need of new corneas.
Patients are given topical anesthesia so they can't feel anything during the DSAEK procedure. First, the surgeon cuts and prepares the donor cornea. Next, he or she makes a mark in the surface of the patient's cornea with a trephine (an instrument used to cut circular sections of tissue). That mark serves two purposes: it helps the surgeon determine what size the transplant should be, and it outlines the area of the patient's cornea that needs to be peeled away.
Next, the surgeon scores the damaged section of the cornea and strips the membrane away from the eye using a microkeratome blade – the same instrument used in LASIK surgery. Then the donor cornea is folded into a "taco" shape and placed on the eye. A single stitch closes the incision.
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DSAEK is the latest advancement in corneal transplantation technology.
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Sometimes the new cornea unfolds on its own; other times, the surgeon unfolds it him/herself. When it is unfolded, a second stitch is made to close the wound and anchor the new cornea in place. The surgeon then injects an air bubble underneath the cornea, making sure it is centered on the eye, and dilates the pupil with eye drops.
Patients are sent to the recovery room for about one hour, after which they are examined at the slit lamp with the doctor. He or she gently presses on the cornea until most of the air bubble is released. Patients are then given antibiotics and steroid eye drops and will return the next day for a follow-up appointment. The most common side effect (about 10% of patients) is the need for a second bubble injection to re-center the cornea.
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