Our Summary

This research paper focuses on a surgical procedure known as deep anterior lamellar keratoplasty (DALK), which is used to treat cornea disorders that don’t affect the innermost layer of the cornea, the endothelium. DALK is a safer alternative to another procedure called penetrating keratoplasty (PK) as it reduces the risk of transplant rejection and failure by preserving the patient’s own endothelium.

Despite its benefits, DALK was known to be a complex and time-consuming process, which made it less popular. However, the introduction of the “big-bubble technique” (BBT) has improved the procedure’s efficiency and reproducibility. In BBT, air is injected into the cornea to separate the diseased layers from the healthy ones. This makes it easier to replace the diseased parts while leaving the healthy ones intact, leading to outcomes comparable to PK.

The paper also discusses the importance of understanding the cornea’s structure for successful BBT. For instance, the discovery of a layer in the cornea, known as Dua’s layer, significantly improved the safety and consistency of BBT. The paper mentions that various factors like the patient’s condition before the operation, the size of the surgical device used, and the tools used for air injection can influence the success of the procedure.

In conclusion, the paper provides a comprehensive overview of DALK using BBT, including its challenges, latest improvements, and how to manage common complications. The authors believe that ongoing advancements are enhancing the technique’s effectiveness and applicability whenever the endothelium is healthy.

FAQs

  1. What is deep anterior lamellar keratoplasty (DALK) and how does it differ from penetrating keratoplasty (PK)?
  2. What is the “big-bubble technique” (BBT) and how has it improved the DALK procedure?
  3. What factors can influence the success of the DALK procedure using the BBT?

Doctor’s Tip

One helpful tip a doctor might tell a patient about corneal transplant is to follow all post-operative care instructions carefully. This may include using prescribed eye drops, avoiding rubbing or touching the eye, wearing protective eyewear, and attending follow-up appointments. By following these instructions, the patient can help ensure the success of their corneal transplant and minimize the risk of complications.

Suitable For

Patients who are typically recommended for corneal transplant, specifically deep anterior lamellar keratoplasty (DALK) using the big-bubble technique (BBT), include those with corneal disorders that do not affect the endothelium. These disorders may include keratoconus, corneal scarring, corneal dystrophies, and other conditions that affect the outer layers of the cornea.

Additionally, patients who have a healthy endothelium and are at risk of rejection or failure with a traditional penetrating keratoplasty (PK) may also be recommended for DALK with BBT. The procedure is considered a safer alternative to PK in these cases as it preserves the patient’s own endothelium, reducing the risk of rejection and improving long-term outcomes.

Overall, patients who can benefit from DALK with BBT are those with corneal disorders that do not involve the endothelium and who have a healthy endothelium that can be preserved during the procedure. These patients may experience improved visual outcomes and reduced risk of complications compared to traditional PK.

Timeline

Before the corneal transplant:

  • The patient undergoes a comprehensive eye examination and consultation with an ophthalmologist to determine the need for a corneal transplant.
  • The patient is informed about the risks, benefits, and expectations of the procedure.
  • Preoperative tests, such as blood tests and imaging scans, are conducted to assess the patient’s overall health and eye condition.
  • The patient may be required to stop taking certain medications or adjust their lifestyle habits before the surgery.

After the corneal transplant:

  • The patient is monitored closely in the immediate postoperative period to check for any signs of complications or rejection.
  • The patient may experience discomfort, blurry vision, and light sensitivity in the first few days after the surgery.
  • The patient is prescribed medications, such as eye drops, to prevent infection and promote healing.
  • Follow-up appointments are scheduled to monitor the progress of the transplant and adjust the treatment plan as needed.
  • It may take several weeks to months for the patient’s vision to stabilize and improve after the surgery.
  • The patient is advised to avoid activities that may increase the risk of injury to the eye, such as rubbing or touching the eye, swimming, and heavy lifting.

Overall, the timeline of a patient’s experience before and after a corneal transplant involves thorough preparation, close monitoring, and ongoing care to ensure a successful outcome and improve vision quality.

What to Ask Your Doctor

Some questions a patient should ask their doctor about corneal transplant using DALK with BBT include:

  1. Is DALK with BBT the best option for my specific cornea disorder?
  2. What are the potential risks and complications associated with this procedure?
  3. How long is the recovery process, and what can I expect during the post-operative period?
  4. What is the success rate of DALK with BBT compared to other corneal transplant procedures?
  5. Will I need to take any medications after the surgery, and if so, what are the potential side effects?
  6. How often will I need to follow up with my doctor after the procedure?
  7. Are there any specific lifestyle changes I should make to ensure the success of the transplant?
  8. What is the expected long-term outcome of the transplant, and how often will I need to have it monitored?
  9. Are there any alternative treatments to consider before opting for a corneal transplant?
  10. Do you have experience performing DALK with BBT, and what is your success rate with this procedure?

Reference

Authors: Moramarco A, Gardini L, Di Mola I, di Geronimo N, Iannetta D, Romano V, Hannush SB, Fontana L. Journal: Ocul Surf. 2024 Oct;34:418-429. doi: 10.1016/j.jtos.2024.10.001. Epub 2024 Oct 5. PMID: 39369903