Corneal tissue for transplant comes from an eye bank. The operation consists of transferring the clear central part of the cornea from the donor's eye to the patient's eye. Soon after the operation, the patient can resume activity.
Return of the best vision after corneal transplant surgery may take up to a year, depending on the rate of healing and the health of the rest of the eye. A contact lens may be required to obtain one's best vision after corneal transplant surgery. As in any transplant, rejection of the donated tissue can take place. The major signs of rejection are redness of the eye or worsening of vision. If these occur, a prompt return to an ophthalmologist is necessary even if it is years after the original operation.
Eat a light meal and take your usual medications. Please use whatever medical eye drops (for example, for glaucoma) that you would normally use for the operative eye on the same day as the surgery.
The surgery is usually performed under conscious sedation with a local anesthetic of your eye. Our Certified Registered Nurse Anesthetist (CRNA) will administer a sedative intravenously, and then after you are sedated, he/she will completely numb your eye. Patients rarely remember the numbing procedure, and once the eye is numb, they should not experience any discomfort during the surgical procedure. This also prevents you from seeing the surgery or moving the eye. The CRNA also gives you medicine by vein to keep you relaxed and a little sleepy during the surgery. Using local anesthesia avoids many risks to your heart or lungs that complete general anesthesia involves.
During the surgery, a single line incision with a length of only 5 millimeters is made in the sclera (the white part of the eye), a pocket is formed into the cornea, and the diseased endothelial layer of your cornea will be removed (descemets layer). The healthy donor endothelium and back layer of the donor cornea are placed through the incision and pocket and placed into position on the back surface of your cornea to replace the diseased tissue.
The initial incision is then closed with one to three small sutures and the procedure is completed. A small air bubble is left inside the eye to help ensure the stability of the donor transplant tissue and it is most effective when lying down on your back, facing the ceiling. This air bubble is simply absorbed and disappears over about 48 hours.
The surgical procedure will take about one hour to perform, slightly longer than a standard full thickness corneal transplant (45 minutes).
Post-Op & Recovery
You will be in the recovery room for about an hour after the surgery, lying flat on your back facing the ceiling. You may then return to the operating room to perform the final stage of the procedure which typically takes an additional 15 minutes.
The entire visit can take as long as 3 - 4 hours before you are ready to go home.
Immediately after Surgery
We will advise you to lie flat on your back, facing the ceiling as much as possible after the surgery for the first 24 hours. You can go to the bathroom or sit up for eating meals as much as necessary in that first 24 hours after surgery and it is not a danger to your transplant to do so, but whenever possible, try to rest in bed lying on your back and facing the ceiling. (one pillow is OK). This will allow the small air bubble inside the eye to best stabilize the transplant tissue.
Post Op Visits
You will visit our office the day after surgery, where the patch will be removed and need not be re-applied. You will, however, be asked to wear a protective shield over the eye (without a patch) at night while sleeping for 1 week. No protection is needed during the day, but if you normally wear glasses for the other eye, go ahead and wear them. You will be placed on antibiotic and steroid drops to prevent infection and help with healing. You will have a brief visit to the clinic one week after surgery, and then again at one and three months.
Immediately after surgery, we would like you to be lying down on your back facing the ceiling and resting as much as possible for the first 24 hours. Anesthesia can cause some people nausea so go slowly eating the evening you have surgery.
Most normal activities are permitted even the first day after surgery. You can shower and wash your hair. Remember, however, you are at risk for infection for the first two weeks after surgery, so avoid all activities that put you at risk for infection (like gardening, working in dirty environments etc.) Use common sense and it will be fine.
Finally, avoid any activities that may lead to taking a direct hit to the eye or pressure on the eye. No sports activities of any kind for 2 weeks after surgery. No swimming under water for 4 weeks but doing water exercises (head always out of water) is fine after two weeks.
When the patch is removed, you will have poor vision for the first several days which will allow you to only see well enough to count fingers from 2 feet away. Vision is poor because the donor tissue is still swollen. Although the new cornea begins clearing your cornea almost immediately, it does so in patches.
By one week, most patients know their cornea is getting better and their vision is clearing.
By one month, after the vision is typically much improved and patients feel that success is at hand. A gradual improvement typically continues over the next three months.
By one year, over 65% of patients have 20/40 or better vision. The patients that have no other ocular problems (like macular degeneration or other retinal diseases) have the best vision of all after DSEK surgery.
The vision continues to improve over time, with many patients improving their vision even from one to two to three years after surgery.
The ultimate vision after DSEK surgery will depend more upon the health of the patient's retina and central vision of the macula than upon the clarity of the cornea, as nearly all DSEK patients attain a clear cornea with good surface focus after this surgery. A vision of 20/20 is possible, but even with a crystal-clear cornea, vision depends upon the function of the retina and may not attain 20/20. It is most important to remember that while the vision will be better than it was before surgery, vision improvement varies among all patients. Generally, patients that are younger than 65 years old, and patients who have vision better than 20/60 prior to surgery, have the fastest visual recovery. Some of our patients have been 20/25 at just one week after surgery, but these are the exceptions. Patience is still a virtue, even with DSEK surgery.
Donor Disc Dislocation
During your first post-op exam, the surgeon will examine your eye to ensure the donor tissue disc is in the proper position. If the donor disc is NOT in the proper position, then the disc must re-positioned by the surgeon. The risk of this happening is between 2% and 4.5%. Nonetheless, this is a real risk of DSEK surgery. Fortunately, a dislocated donor disc can be successfully re-positioned with good function and restoration of vision over 90% of the time. In the worst-case scenario, if the disc cannot be successfully repositioned with a simple air bubble, we have the option of trying a new donor disc or resorting to a conventional, full thickness corneal transplant.
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