Corneal Transplant Surgery PK DSEK DMEK | PristynCare

Risk Factors

Factors increasing the risk of graft complications include:

• Prior corneal vascularization from inflammation or infection
• History of failed corneal grafts
• Uncontrolled glaucoma or elevated intraocular pressure
• Severe dry eye or ocular surface disease
• Active ocular infections or inflammation
• Poor compliance with post-operative medications

Who is a Good Candidate

Patients with corneal disease causing significant vision impairment that does not respond to medical treatment are candidates for corneal transplantation. Fuchs dystrophy with endothelial cell loss, keratoconus with scarring, and bullous keratopathy are among the most common indications. Patients must have a healthy optic nerve and retina for meaningful visual recovery after surgery.

Diagnosis

Pre-operative assessment for corneal transplantation includes:

• Slit-lamp biomicroscopy for detailed corneal examination
• Specular microscopy to count endothelial cells
• Corneal topography and pachymetry for thickness mapping
• Anterior segment OCT for layer-by-layer analysis
• Visual acuity and potential acuity assessment
• Assessment of optic nerve and retinal health

Treatment Approach

The choice of transplant technique depends on which corneal layer is diseased. DMEK and DSEK are preferred for endothelial disease (Fuchs dystrophy, bullous keratopathy) due to faster recovery and lower rejection rates. DALK is used when the endothelium is healthy but anterior stroma is scarred. PK is reserved for full-thickness corneal disease or failed lamellar grafts. Post-operative immunosuppression with topical steroids is essential to prevent rejection.

Corneal Transplant Procedure Steps

The corneal transplant procedure involves the following steps:

• Pre-operative donor tissue preparation and quality assessment
• General or local anesthesia is administered
• For PK: the recipient cornea is trephined and full-thickness donor tissue is sutured in place
• For DSEK/DMEK: the recipient Descemet membrane is stripped and donor tissue is inserted through a small incision
• An air bubble is injected to unfold and adhere the donor tissue to the recipient stroma
• The patient lies flat for 1 hour post-operatively to allow graft attachment
• Sutures are placed as needed based on technique used
• Topical antibiotic and steroid drops are started immediately post-surgery

Recovery After Transplant

Recovery after corneal transplantation requires:

• Use of topical steroid and antibiotic eye drops for several months to years
• Avoid rubbing or bumping the eye at all times
• Wear protective eyewear in public for 6 to 12 months
• Report any sudden pain, redness, or vision drop immediately as it may indicate rejection
• Regular follow-up every 1 to 3 months in the first year
• Vision may take 6 to 12 months to stabilize after PK; faster with DMEK

Risks and Complications of Corneal Transplant

Possible complications of corneal transplantation include:

• Graft rejection: Immune-mediated response to donor tissue; requires urgent steroid treatment
• Primary graft failure: Non-functioning graft immediately after surgery due to donor tissue damage
• Graft detachment: Particularly relevant in DMEK; may require repositioning
• Infection: Bacterial or viral keratitis in the graft
• Elevated intraocular pressure: Risk of steroid-induced or pre-existing glaucoma
• High astigmatism: Especially after PK, correctable with glasses or contact lenses
• Recurrence of original disease: Some corneal dystrophies can recur in the donor tissue