Cornea Transplants (DSEK, DSAEK, DMEK, DALK, and PKP) – Greenbelt, MD

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About Cornea Transplants

Corneal transplantation was the first human transplant and is one of the most frequently performed transplants in the U.S. annually. Since the inception of the modern-day Penetrating Keratoplasty (PKP) in the early 1960s, over half a million successful cases have restored vision to men, women, and children of every age.

The human cornea has five layers: the epithelium, Bowman's layer, the stroma, Descemet's membrane, and the endothelium. Depending on which layer of the cornea has been compromised, there are several remarkable treatments available today that can help stop vision loss and sometimes even restore lost vision. Descemet's Stripping Endothelial Keratoplasty (DSEK) and Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) address damaged or diseased tissue in the endothelial layer of the cornea. Descemet's Membrane Endothelial Keratoplasty (DMEK) involves only the Descemet membrane. Deep Anterior Lamellar Keratoplasty (DALK) involves only the two topmost layers, the epithelium and the stroma. Penetrating Keratoplasty (PKP) is the removal and replacement of the full thickness of the cornea.

Our experts at Solomon Eye Physicians and Surgeons are among the most knowledgeable and skilled corneal surgeons in Maryland. If you have a corneal disease, disorder, or injury, make an appointment for an exam and evaluation at our Greenbelt or Bowie, MD office. We'll determine the absolute best treatment for your situation and make sure you have all the information necessary to decide on your next steps.

Best Candidates

The best candidates for a corneal transplant are those who are in good overall health and whose corneal conditions cannot be managed with less-invasive methods, such as superficial keratoplasty, medications, or prescription lenses. Each patient considering a cornea transplant with Solomon Eye Physicians and Surgeons is required to undergo a thorough evaluation to determine candidacy; however, some common issues our cornea transplant patients experience includes: 

  • Advanced keratoconus
  • Fuchs' dystrophy
  • Deep corneal scarring
  • Corneal clouding and/or swelling
  • Rare complications following LASIK

DSEK and DSAEK
Descemet's Stripping Endothelial Keratoplasty (DSEK) and Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) are performed for patients who have problems in the endothelium (bottom layer of the cornea), such as Fuchs' endothelial dystrophy and Iridocorneal endothelial syndrome (ICE), or have had a previous failed endothelial keratoplasty.

DMEK
Descemet's Membrane Endothelial Keratoplasty, or DMEK, is a reliable and beneficial surgical technique for Fuchs’ corneal dystrophy and corneal endothelial dysfunction. DMEK does not have any impact on the external shape of the cornea, which is very advantageous since any irregularity in the corneal shape has a major impact on vision.

DALK
Deep Anterior Lamellar Keratoplasty (DALK) is performed to correct conditions that result in corneal thinning, distortion, or scarring, such as advanced keratoconus, LASIK- or radial keratotomy-induced corneal thinning, corneal dystrophy, infection, or trauma. The most suitable candidates for this procedure generally have healthy cornea endothelium, no Descemet’s membrane scarring, and:

  • Keratoconus or LASIK-induced corneal ectasia (thinning) and are gas permeable hard contact lens intolerant and are poor candidates for INTACS
  • Cornea scarring restricted to the Bowman’s membrane or stroma
  • Irregular astigmatism and are intolerant of hard contact lenses
  • Complications from Radial Keratotomy (RK)
  • Infectious keratitis unresponsive to medication

PKP
Penetrating Keratoplasty (PKP) is a full-thickness corneal transplant for patients whose condition or injury has affected the cornea at each layer. 

Procedure details

You will meet with Dr. Solomon for an examination in the weeks to months prior to surgery. Dr. Solomon will examine the eye and diagnose the condition. He will then discuss the different treatment options and their risks and benefits. Should you elect to proceed with surgery from Dr. Solomon, you must sign an informed consent form. Then a date and time will be set for the procedure. You will be asked to see your primary care physician for a medical evaluation prior to your surgical date. Please bring a list of all your medications with you to the exam.

Understanding the procedures and potential complications is imperative. Research your options and ask for references.

DSAEK and DSEK
Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) is the newest technique in corneal transplantation currently being used. In the procedure, the Descemet's membrane (the protective layer between the stroma and endothelium), as well as thin portions of the stroma and endothelium, are removed and replaced with that of a donor. DSAEK and DSEK are essentially the same procedure; DSAEK is simply the newer, partially automated version. As a result of the smaller incisions used, the need for sutures is gone. Therefore, the safety and success of this revolutionary procedure are unprecedented with over 90% of all transplants restoring the recipient's vision. Vision is usually restored in 1 – 3 months. 

DMEK
With DMEK, only the Descemet’s membrane and endothelium (no stromal tissue) are transplanted, allowing for a smaller insertion incision, faster visual recovery (days to weeks), and less refractive changes following the procedure. The DMEK procedure is more challenging to perform due to the fragility of the transplanted graft; however, the corneal surgeons at Solomon Eye Physicians and Surgeons have special training and extensive experience performing this procedure.

DALK
DALK is a partial-thickness graft that preserves the two inner-most layers of the cornea (the Descemet’s membrane and endothelium) while removing and replacing only the diseased, weakened, or scarred anterior layers (epithelium and stroma) with donor tissue. The retention of these inner layers may not only make a DALK graft last a lifetime and avoid rejection but also allows the creation of larger-diameter grafts.

PKP
Until recently, the gold standard for cornea transplants was the penetrating keratoplasty, or PKP. This procedure replaces a full-thickness (all five layers), disc-shaped segment of the impaired cornea with a similarly shaped segment of healthy donor cornea.

Follow-Up

Following your procedure, you will need to lie flat on your back for one hour while the donor tissue settles into position. Dr. Solomon will then examine the eye before you are allowed to leave the surgical center. Once you arrive at home, you will have to remain in a reclined position until your first follow-up visit the next day. You will then return one week after the operation, and then every month for the next three months for continuing follow-ups.

Most patients are able to resume normal activities the next day, wear eye makeup after one week, and swim after four weeks. You will be prescribed an antibiotic eye drop to use for one week following surgery, as well as a mild anti-inflammatory drop to use for 9 – 12 months to help minimize the chance of rejection.

Following a cornea transplant, patients can expect partially or fully restored vision anywhere from 1 month – 2 years after surgery, depending on the type of transplant performed.

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At Solomon Eye Physicians and Surgeons, we are proud to be skilled in the most advanced methods and technologies in the eye care field. Our experienced surgeons can provide you with innovative and effective treatment options, including cutting-edge cornea transplant techniques. Contact our Greenbelt or Bowie, MD office to schedule your first evaluation and begin your journey to clearer vision.

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*Individual results are not guaranteed and may vary from person to person. Images may contain models.