The Cornea & DSAEK
Several diseases can effect the cornea, or clear covering of the eye, such as Fuchs Dystrophy, which causes cloudy vision, and Keriticonus, which creates distortion through extreme astigmatism. Surgery can correct some conditions, but in some cases, a corneal transplant is needed. DSAEK is a new, advanced technique that uses a small, suture-less incision to remove just the back layer of the cornea. This provides great results with a much faster recovery time than in traditional cornea transplant surgery.
Dr. Cavanaugh: The cornea is the front window covering of the eye, it's what I call, kind of, the watch crystal of the eye so it's the clear bubble that covers the pupil and covers the colored part of the eye. But it's a very important structure because it has two- thirds of the focusing power of the eye so the cornea needs to be smooth and clear in order to focus things properly. Unfortunately, there are diseases that affect the cornea that affect either its clarity or the smoothness of the cornea and sometimes that requires surgical intervention and that may be something as simple as polishing the cornea or it may require corneal transplantation. And so a wide variety of patients can have a wide variety of different diseases. Some diseases, such as dystrophies, will cause a clouding of the cornea, the most common which is Fuchs Dystrophy which causes a swelling and clouding of the cornea and that's an inherited condition. And we see another condition called keriticonus where the cornea becomes cone-shaped rather than being a dome like it should be, it becomes progressively steeper and that distorts the vision, causes tremendously bad astigmatism. Patients can have infections that leave scars on the cornea, viruses or bacteria, or what have you, so there's a whole host of things that we can treat. Because the cornea is an avascular structure meaning, it has no blood vessels in it, we don't need to cross-match those tissues so there's no wait list trying to find a donor that matches exactly. And because of that the corneal transplant availability is quite good. We have a tremendous eye bank in the Kansas City area called the Heartland Lions Eye Bank. And they are able to process our requests and typically our patients are able to have surgery on the given date. So there's a procedure called desec, which has been the absolute most advanced, the greatest advance that I've seen in 20 some-odd years of being a corneal transplant specialist. With desec we're able to go through a small incision that's suture-less similar to cataract surgery. We peel off the bad cells off the back of the cornea then we replace just that layer itself. So the patient keeps 80 to 85% of their own cornea and we're just replacing the back layer. The procedure is all done suture-less. Typically, in my hands about 15 minute outpatient procedure. And the results are great and visual recovery is dramatically faster than with a full thickness transplant. You're talking versus a year versus a month to achieve similar vision results. Less complications, don't have to worry about sutures and it's been a huge, huge advance. Desec can be done in combination with cataract surgery and oftentimes patients have both diseases, so through the same incision we can remove cataracts and take care of the corneal transplant needs in the same operation.