65756 Keratoplasty (corneal transplant); endothelial

Name of the Procedure:

Keratoplasty (corneal transplant); endothelial, also known as Endothelial Keratoplasty (EK) or Descemet's Membrane Endothelial Keratoplasty (DMEK).

Summary

In layman's terms, an endothelial keratoplasty is a corneal transplant surgery where only the innermost layer of the cornea, the endothelium, is replaced with healthy tissue from a donor. This helps restore vision that has been clouded due to damage or disease affecting this part of the cornea.

Purpose

Endothelial keratoplasty is performed to address issues with the cornea's innermost layer, the endothelium, which is responsible for keeping the cornea clear by pumping out excess fluid. The main goal is to restore clear vision by replacing dysfunctional endothelial cells with healthy ones.

Indications

• Fuchs' endothelial dystrophy
• Posterior polymorphous corneal dystrophy
• Irreversible endothelial failure post-cataract surgery
• Corneal edema (swelling) causing vision impairment

Preparation

• Fasting for a certain number of hours before the procedure (usually 6-8 hours).
• Adjusting current medications as advised by the healthcare provider, particularly blood thinners.
• Undergoing a comprehensive eye examination and possibly imaging tests like corneal topography.
• Arranging for a responsible adult to transport the patient home post-surgery.

Procedure Description

1. The patient is given local or general anesthesia depending on the case specifics.
2. The surgeon makes a small incision in the cornea.
3. Diseased endothelial cells are carefully removed.
4. The donor cornea is prepped by isolating the endothelial layer and associated tissue.
5. The graft is inserted into the patient's eye and positioned correctly.
6. The new endothelial layer is attached using a bubble of air to press it into place.
7. The eye may be patched to help with initial healing.

Duration

The procedure typically takes about 45 to 90 minutes.

Setting

Endothelial keratoplasty is usually performed in an outpatient surgical center or hospital.

Personnel

• Ophthalmic Surgeon
• Surgical Nurse
• Anesthesiologist (if general anesthesia is used)
• Surgical Technologist

Risks and Complications

• Graft rejection
• Infection
• Increased intraocular pressure (glaucoma)
• Detached or dislocated graft
• Vision fluctuations or blurriness
• Cataract formation (if general anesthesia was used)

Benefits

• Restoration of clear vision
• Quick visual recovery compared to full-thickness corneal transplants Benefits might be noticeable within weeks, but full recovery may take several months.

Recovery

• Regular follow-up appointments to monitor healing.
• Eye drops to prevent infection and inflammation.
• Avoiding strenuous activities and heavy lifting for a few weeks.
• Protecting the eye from injury or contamination.

Alternatives

• Penetrating Keratoplasty (full-thickness corneal transplant): Involves replacing the entire cornea.
• Advanced contact lenses or glasses: For less severe cases, though not effective for all conditions treated by EK.
• Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK): An alternative form of partial-thickness corneal transplant, which uses a slightly thicker donor tissue layer.

Patient Experience

During the procedure, the patient will be under local or general anesthesia, ensuring no pain is felt. Post-procedure, mild discomfort or a gritty sensation in the eye can be managed with prescribed medications. Clear vision often returns gradually over several weeks. Regular follow-up and adherence to care instructions are crucial for optimal recovery and results.