What Is Keratoplasty?

Keratoplasty describes a surgical procedure to replace your eye’s damaged or diseased cornea with donated corneal tissue. Your cornea is the clear, dome-shaped layer of tissue at the very front of your eye. Light enters your eye through the cornea, so when it’s damaged, your eyesight suffers.

After a cornea transplant, you can expect improved vision and reduced pain. While all surgical procedures carry minimal risk, keratoplasty surgery is safe and effective. You reduce the risks even more by relying on the experienced and well-reviewed ophthalmologists at Vitreous Retina Macula Consultants of New York (VRMNY). These award-winning eye doctors have done groundbreaking research, developed new techniques and published peer-reviewed articles in the nation’s top medical journals.

Why Is Keratoplasty Surgery Necessary?

Eye doctors usually recommend keratoplasty when cornea damage ruins your vision. Your cornea helps focus light rays onto your retina, which is the light-sensitive area at the back of your eye. The retina sends images to your brain through your optic nerve. But the process begins with the light that enters your eye through the cornea.

While poor vision is the most common reason for keratoplasty, your ophthalmologist may also recommend a corneal transplant for other reasons, such as to address:

• Eye pain
• The outward bulging of your cornea, a condition called keratoconus
• Corneal deterioration
• A tear in your cornea
• Corneal scarring
• A cornea infection
• A trauma or injury of your cornea
• Corneal edema or swelling
• Ulcers in your cornea that haven’t improved with other treatments
• Corneal damage from a previous eye surgery

What Are the Types of Keratoplasty Surgery?

Keratoplasty is an umbrella term for several different specialized cornea-related procedures. Your actual procedure depends on whether your eye doctor decides to remove the entire thickness or just a section of your cornea that’s diseased or damaged. It all depends on your cornea’s condition and the diagnosis. Your VRMNY ophthalmologist may choose a technique from many possibilities, including:

• Conductive keratoplasty (CK). This procedure is approved by the Food and Drug Administration (FDA) to treat presbyopia, a condition that degrades your ability to see things up close. Most often an age-related condition, the usual treatment is reading glasses or special contact lenses. If your VRMNY surgeon opts for CK, it means applying a high-frequency, low-energy radio wave signal through a metal-tipped instrument to the edge of your cornea. This technique alters your cornea’s collagen to improve your vision by making your cornea’s shape steeper.
• Penetrating keratoplasty (PK). A PK involves a transplant of the full thickness of your cornea. Your eye surgeon uses a specialized precision instrument to make a circular incision. After cutting through the entire thickness of the damaged cornea, your doctor extracts a small disk of corneal material. Then the doctor inserts an equal-sized donated cornea as a replacement, using sutures to keep the transplant in place.
• Endothelial keratoplasty (EK). During an endothelial keratoplasty procedure, your VRMNY ophthalmologist removes the innermost endothelium layer, along with the thin tissue layer that protects it, called the Descemet’s membrane. For a Descemet stripping endothelial keratoplasty (DSEK), your surgeon replaces about one-third of your cornea with donor tissue. Descemet membrane endothelial keratoplasty (DMEK) is a more difficult technique that uses a very thin, delicate portion of donor tissue.
• Anterior lamellar keratoplasty (ALK). During an ALK, your eye surgeon removes the diseased tissues from the front of your cornea — and possibly more. It leaves your cornea’s protective endothelium in place. Your surgeon has two options, depending on the severity of damage to your cornea. During a superficial anterior lamellar keratoplasty (SALK), the doctor replaces only the outermost tissue. If you need a deep anterior lamellar transplant (DALK), the surgeon also removes the stroma and epithelium of the cornea. In each case, your ophthalmologist grafts donor tissue to replace the removed portion of your cornea.
• Artificial cornea transplant, also known as a keratoprosthesis. If you’re ineligible for a donor cornea or your body has previously rejected one, your eye doctor may recommend keratoprosthesis. While never the first choice, this procedure can save your sight.

VRMNY has some of the nation’s top ophthalmologists, so you can trust that you’ll get the right corneal transplant for your needs. When you meet with your doctor for an initial consultation, you spend part of the time confirming which procedure would best help you.

What Can I Expect from My Keratoplasty?

Before the surgery, your doctor administers either a local or general anesthetic, depending on the procedure chosen. Most often, all you need is some local anesthesia. It’s a painless experience performed in the VRMNY offices in Manhattan, Brooklyn or Westchester. The length of time your eye surgeon needs depends on the complexity of the procedure.

After your doctor has completed the procedure, you may rest for a while before being released. You need to arrange for a ride home, as you’re encouraged not to drive yourself. You’re given a set of instructions to promote healing and recovery that usually include:

• Medications. Take eye drops or oral medicine.
• Eye protection. Wear an eye shield, patch or glasses.
• Allow your cornea a chance to heal.
• Eye care. Avoid rubbing your eye.
• Take it slowly. Don’t participate in any strenuous activity.
• Follow-up treatment. Your doctor sets follow-up appointments to monitor your recovery.

Keratoplasty usually restores your vision, and any surgical complications are rare and minor. Choosing the top-rated ophthalmologists at VRMNY for your procedure increases your chance of success and reduces the possibility of any problems. Contact the eye specialists today to schedule your initial consultation.