Center for Sight
Comprehensive Eye Care Center
Corneal infections are a potential cause of discomfort and vision loss if not diagnosed and treated promptly. An infection of the cornea is called Keratitis. Keratitis can cause a painful inflammation with a discharge, which if not treated quickly and appropriately, can lead to corneal erosion, corneal ulceration and corneal scarring. If Dr. Johnson suspects that you have a corneal infection, she will look for certain diagnostic signs to help decide the best course of treatment which might be an antibiotic eye drop, an antifungal eye drop, an antiviral eye drop and sometimes it might even include a steroid eye drop to reduce the inflammation.
Penetrating Keratoplasty involves the surgical removal of the central two-thirds thickness of the damaged cornea with a “cookie cutter” like instrument called a trephine, and replaces it with a clear cornea obtained from the eye bank. She then very carefully sews the donor cornea into place using sutures that are thinner than a human hair. To facilitate the healing of the new transplanted cornea, Dr. Johnson prescribes eye drops for patients who have had corneal transplants. After she has determined that the new cornea has healed properly, Dr. Johnson will remove the fine sutures or stitches he put in place during the surgery. This is the most common type of Corneal Transplant. This type of transplant has the potential to provide the clearest vision after healing because there is no interface (layer) to look through. However, the healing time is longer and the use of a contact lens might be required for the clearest vision.
Lamellar Keratoplasty may be performed if the damaged corneal tissue is mainly located in the outermost 50% of the cornea. Essentially, she will carefully dissect the outermost half of the cornea and remove it along with the damaged tissue. Then a new donor cornea is sewn into place. This corneal transplant is less invasive and will allow your eye to be stronger after surgery than it would be with a regular full thickness transplant, or Penetrating Keratoplasty. However, in some cases there can be some loss of clarity from the interface between the new and remaining layers of the cornea.
Descemet’s Stripping with Endothelial Keratoplasty (DSEK) is performed through a small incision, to remove and replace the inner cell layer of the cornea when it stops working properly. With this technique, the surgeon gently “strips” off the single diseased cell layer, called the endothelium, and leaves the remaining cornea intact. Dr. Johnson will then thinly slice a donor cornea from the eye bank and fold the back portion in half and inserts it through a small incision into the eye. She will then insert an air bubble to unfold and position the donor tissue on the recipient cornea. Within a few minutes the donor tissue attaches to the recipient without the use of any sutures. There are several advantages of DSEK if you are indeed a candidate including the eye remaining much stronger, a quicker visual recovery and minimal change in your eyeglass prescription.