Management of Diseases of the Cornea

Management of Diseases of the  Cornea is our main expertise, especially cornea transplants.

Until recently the disorders of cornea requiring transplantation were handled with full thickness transplant (penetrating keratoplasty), however with the recent advances in surgical techniques, this type of transplant is indicated just in the minority of patients. The new techniques are performed less invasively, reducing risks and complications and accelerating the recovery time, all this has improved the prognosis and outcome of corneal transplantations.

PKP: the full thickness of the cornea is removed and a healthy, also full thickness cornea is sutured to the remaining periphery of the host cornea to keep it in place, sutures must be in the cornea for around one year to allow an adequate healing.

Lamellar transplants: These are currently performed in most of our patients, in these surgeries only part of the cornea (the diseased layers) are replaced, thereby reducing the most serious complications that can occur during surgery, and especially decreasing significantly the main complication of full transplant (PKP): rejection of the new cornea.

Deep anterior lamellar Keratoplasty: (DALK) In this surgery the anterior layers of the cornea are changed when they are damaged (keratoconus, scars, stromal dystrophies) and posterior layers (endothelium and Descemet’s membrane) are preserved, so the risk of rejection of the new cornea is reduced to almost zero, because rejection is usually directed to the posterior layers.

Posterior lamellar transplantation, Endothelial transplants: DSAEK and DMEK, Only the abnormal posterior layers (Descemet’s membrane and endothelium) are removed from the diseased cornea and replaced with a healthy tissue. The procedure is done through a very small incision, allowing a less invasive surgery, a faster and better visual recovery, giving the best possible vision after corneal transplantation. The results of these endothelial transplants are much better that PKP outcomes. The most frequent indications are bullous keratopathy (corneal edema) associated with cataract and endothelial dystrophies.

Keratoprotesis:

It is the last resource in patients whom a transplant is not feasible because of the severity of ocular lesions, or it is contraindicated because of poor prognosis (Multiples previous rejections, limbal stem cell disease, scarring diseases of the ocular surface). The damaged cornea ​​is removed from the eye and replaced with the device (artificial cornea: Boston Keratoprostesis type 1), allowing a clearing in the front of the eye, and regaining vision.