Our Summary

This study examined the effectiveness and safety of different types of corneal transplant surgeries, specifically deep anterior lamellar keratoplasty (DALK), Descemet’s stripping automated endothelial keratoplasty (DSAEK), penetrating keratoplasty (PK), and patch grafts. Researchers looked at 139 eyes that had undergone one of these surgeries between 2000 and 2016. They reviewed patient information, the reasons for surgery, risk factors, and results, including any complications.

The team found that patients who had DALK and DSAEK surgeries had better chances of their new corneas surviving after three years, compared to those who had PK or patch graft surgeries. They also discovered that there were fewer complications with DALK and DSAEK procedures than with PK. However, the final visual outcomes were similar across all surgery types. The survival rate for patch grafts was lower than expected, although there were few complications.

In simple terms, this study found that DALK and DSAEK may be better options for corneal transplant surgeries because they have lower complication rates and higher survival rates, but all types of surgeries had similar final vision results. Patch grafts had a lower survival rate, but also had few complications.

FAQs

  1. What types of corneal transplant surgeries were examined in this study?
  2. What were the findings regarding the survival rate and complications of DALK and DSAEK surgeries compared to PK and patch graft surgeries?
  3. Did the effectiveness of the transplant surgeries vary in terms of the final visual outcomes?

Doctor’s Tip

A doctor might advise a patient considering a corneal transplant to discuss the possibility of DALK or DSAEK surgeries with their surgeon, as these options may have better outcomes in terms of corneal survival and complication rates. It is important for the patient to weigh the risks and benefits of each type of surgery and make an informed decision with their healthcare provider.

Suitable For

Patients who are typically recommended for corneal transplant surgeries are those who have corneal diseases or conditions that cannot be treated effectively with other methods, such as medications or contact lenses. These conditions may include:

  1. Keratoconus: a progressive thinning of the cornea that causes it to bulge outward and become cone-shaped.

  2. Fuchs’ dystrophy: a gradual loss of endothelial cells in the cornea, leading to fluid buildup and cloudy vision.

  3. Corneal scarring: caused by injuries, infections, or previous surgeries, leading to distorted or impaired vision.

  4. Corneal edema: swelling of the cornea due to fluid buildup, causing blurry or hazy vision.

  5. Corneal degeneration: age-related changes in the cornea that affect its clarity and transparency.

  6. Corneal infections: severe infections that have caused significant damage to the cornea.

  7. Corneal dystrophies: inherited disorders that affect the structure and function of the cornea.

Overall, patients with significant corneal damage or diseases that affect their vision and quality of life are typically recommended for corneal transplant surgeries. It is important for patients to consult with their eye care provider to determine if they are suitable candidates for a corneal transplant and which type of surgery would be most beneficial for their specific condition.

Timeline

Timeline of patient experience before and after corneal transplant:

Before surgery:

  1. Patient experiences vision problems such as blurred vision, sensitivity to light, or distorted vision.
  2. Patient undergoes thorough eye examinations to determine the need for a corneal transplant.
  3. Patient is informed about the different types of corneal transplant surgeries and the risks and benefits associated with each procedure.
  4. Patient is placed on a waiting list for a suitable donor cornea.
  5. Patient undergoes pre-operative evaluations and tests to ensure they are a suitable candidate for surgery.

After surgery:

  1. Patient undergoes the corneal transplant surgery, which can be DALK, DSAEK, PK, or patch graft, depending on the recommendation of the surgeon.
  2. Patient is monitored closely in the immediate post-operative period for any signs of complications such as infection or rejection.
  3. Patient may experience discomfort, light sensitivity, and blurred vision in the days following surgery.
  4. Patient is prescribed eye drops and medications to prevent infection and rejection and promote healing.
  5. Patient attends follow-up appointments to monitor the progress of the transplant and adjust medications as needed.
  6. Over time, patient’s vision gradually improves as the new cornea heals and stabilizes.

What to Ask Your Doctor

Some questions a patient should ask their doctor about corneal transplant surgery include:

  1. What type of corneal transplant surgery do you recommend for me, and why?
  2. What are the potential risks and complications associated with the recommended surgery?
  3. What is the expected success rate and survival rate of the new cornea after surgery?
  4. How long is the recovery process, and what can I expect in terms of post-operative care?
  5. Are there any specific factors or conditions that may affect the outcome of the surgery in my case?
  6. How will my vision be affected after the surgery, and what are the expected visual outcomes?
  7. What are the alternatives to corneal transplant surgery, and why do you recommend this specific procedure for me?
  8. How many of these surgeries have you performed, and what is your experience and success rate with this specific type of surgery?
  9. Are there any lifestyle changes or precautions I should take before or after the surgery to ensure the best outcome?
  10. Will I need to take any specific medications or follow-up appointments to monitor the progress of the new cornea after surgery?

Reference

Authors: Ho D, Chai C, Lin H, Htoon HM, Tan AM, Manotosh R, Tan D. Journal: Ann Acad Med Singap. 2018 Mar;47(3):92-100. PMID: 29679087