Although only 20-25% of those with Keratoconus ultimately require corneal transplant surgery, for those who do, it is a crucial and sometimes worrisome decision. However, those who know what to expect before, during, and after surgery are better prepared and feel more in control of their eye care.
Vision varies a great deal after a transplant and continues to change for many months. It may start out very poor and gradually improve or be very good immediately after surgery and then worsen. It could take up to a year to develop good, stable vision.
The more severe the keratoconus is, the more likely it is to see a dramatic improvement immediately after surgery. This is due to the dramatic change that occurs when the bulging and distorted cone is replaced with a new smooth donor graft. While some patients develop good vision while the sutures are still in place, best, most stable vision usually occurs after all the sutures are removed. Suture removal occurs at different times for different patients. It depends on the rate of healing, which is faster in younger people. The majority of keratoconus patients have their sutures removed 6-12 months after surgery.
An important question is the level of uncorrected vision that can be expected after surgery. Will glasses be an option, or will contact lenses still be needed? A small percentage of transplant patients do obtain uncorrected vision good enough that neither glasses nor contacts are needed after surgery, but in the majority of cases, some form of vision correction is needed after surgery. Although vision may not be perfect after surgery, it is nearly always a lot better than it was before.
Our consultants have considerable expertise in various lamellar surgeries like DSEK, DSAEK, DALK etc. DSEK (Descemet Stripping Endothelial Keratoplasty) and DSAEK (Descemet Stripping Automated Endothelial Keratoplasty) refers to a partial thickness corneal transplantation in which a small amount of stroma( a layer of the cornea) and the endothelium( the innermost part of the cornea) is transplanted to a decompensated cornea. DSEK/DSAEK is performed for corneal diseases like Fuch’s endothelial dystrophy, pseudophakic/aphakic corneal edema (corneal decompensation following cataract surgery) and any disorder in which the endothelium is dysfunctional.
Advantages of DSEK are manifold, making this the procedure of choice wherever indicated. The main advantage is the lack of sutures (used in traditional penetrating keratoplasty). Also, following DSEK, the visual recovery is more rapid and astigmatism (irregular shape of the cornea) is lesser.
DALK (Deep Anterior Lamellar Keratoplasty) refers to transplantation of only the top and middle layers of the cornea, leaving the innermost layer (endothelium) of the patient intact. The main advantages of this procedure is minimal/ nil chances of corneal endothelial rejection. DALK is increasingly being performed for keratoconus, other corneal diseases (scars) involving the top and middle portions of the cornea.
FEK ( Femtosecond laser Enabled Keratoplasty) – The newest approach to corneal transplantation uses a femtosecond laser – the same technology used for making flaps in LASIK surgery – to produce incisions in the cornea that enable the surgeon to exercise far more precision in what is removed, so that the transplanted tissue fits into the cornea like interlocking pieces of a puzzle. This dramatically reduces postoperative astigmatism because of the precision of the laser, and it strengthens the wound site, so that it is more resistant to traumatic opening in the event of eye injury following surgery.
The cornea surgeon would examine your cornea and suggest the surgical procedure of choice, that would be the best option in your case scenario. The news is also good for patients with diseased cornea who are not candidates for transplantation using donor tissue. Instead, some of these patients may be candidates for an artificial cornea transplant.