Corneal Disease Explained by Brighton Eye's
NYC Eye Surgery Experts

Service Description

Eye surgery procedures performed on a diseased cornea are varied. There is the Corneal Transplant (PRK), DSEAK, and PTK.

Corneal Transplant (PRK)

In a corneal transplant, the diseased cornea is replaced with a donor cornea. People who need a corneal transplant may have corneal scars, corneal swelling, or very irregular corneas (in conditions such as keratoconus).  Corneal transplants are performed by first removing most of the failed or scarred cornea. Then a new, clear graft is sutured (stitched) in its place. The suture used to stitch the new cornea in place is only a fraction of the width of a hair.

Keratocornus and Corneal scar

Corneal transplants are performed by removing most of the failed or scarred cornea and suturing (stitching) a new, clear graft in its place.  There suture used to stitch the new cornea in place is only a fraction of the width of a hair.

Corneal Transplant

Partial Corneal Transplant (DSEAK)

Descemet's Stripping Endothelial Automated Keratoplasty (DSEAK) is a partial corneal transplant that allows for faster visual recovery and a lower graft rejection rate than a full transplant. If the cornea is swollen but otherwise scar-free, only the endothelium - the back portion of the cornea ("the pumps") - needs to be replaced. A partial transplant is placed in the back of the cornea with an air-bubble that dissolves over 3 days.

Photo-Therapeutic Keratectomy (PTK)

PTK uses the excimer laser to treat corneal surface disease by creating a smoother surface and thus a clearer cornea, while improving the vision. PTK, unlike LASIK and PRK, does not change the patient's dependence on glasses and is considered a medically necessary procedure, which is often paid for by insurance. The conditions that can be treated by PTK are recurrent corneal surface erosions, shallow corneal scars, and corneal dystrophies.

What are some common diseases that affect the cornea?

Corneal edema is the swelling of the cornea due to a disease or trauma to the eye. The most common disease that leads to corneal edema is an inherited condition, known as Fuchs' corneal dystrophy. For patients with corneal edema, a partial corneal transplant DSEAK can significantly improve vision, reduce glare, and increase comfort in the eye.

Other conditions that affect the cornea are corneal scars, resulting from trauma or corneal ulcers, and corneal dystrophies (inherited corneal diseases). For these patients, a full corneal transplant is usually needed to improve vision.

Keratoconus is a relatively common ectasia (disease that causes irregular thinning and astigmatism of the cornea). In its final stages, keratoconus can lead to an irregular, scarred cornea. Here, too, a full transplant may be necessary to improve vision.

Finally, some people may have superficial corneal scars or erosions as a result of corneal diseases or trauma. These patients can benefit from a superficial laser called PTK (photo therapeutic keratectomy).

How do I know if I may be suffering from a corneal condition?

If your cornea appears white, or chronically hurts from scars, swelling, or a corneal degeneration, you may benefit from a corneal transplant.

Where does the transplant come from?
We obtain the corneal grafts (donor transplant tissue) for our transplant procedures from the New York Eye Bank. The Eye Bank procures corneas from recently deceased individuals who agreed to donate their corneas for the benefit of medicine.

Will I be able to see well immediately after the surgery?
Visual recovery after transplant surgery takes time. Usually, there is swelling (edema) in the transplant graft and high astigmatism immediately after surgery. It takes 6 to 12 months for these to improve and for your vision to reach its goal. In the meantime, your doctor may remove sutures from the graft to improve your vision (and reduce astigmatism). Taking your drops as directed after surgery will help the graft heal faster. This should allow your vision to return more promptly.

Will I feel better immediately after surgery?
The first week after surgery, you may feel the stitches in your cornea or the healing surface of the graft. After a few weeks, though, you will find that the discomfort of your old swollen cornea is gone. Eventually, the new graft will feel like your own eye.

Can my body reject the transplant?
There is only a 10% risk of rejection over the lifetime of a transplant (30% risk if your transplant is for Herpes Simplex corneal scarring). The cornea is very well protected from rejection because it does not have any blood vessels coursing through it. It is "immunologically privileged." Still, putting in the appropriate drops after surgery is essential for protecting the cornea from rejection.

Does the transplant last forever?
Current transplants last 10-15 years, at which point they become swollen and too blurry to see through clearly. The transplant can then be repeated with a new graft.
What should I do if my eye feels some pain or foreign body sensation after transplant surgery?
If you have had a corneal transplant and have an unusual feeling the eye (pain, sensitivity to light, foreign body sensation, or decreased vision), you should call us and make arrangements to be seen as soon as possible. Graft rejection and infection are managed best if treated early.

What is the difference between a full and partial corneal transplant (DSEAK)?

A full corneal transplant replaces the entire thickness of the cornea with a donor cornea. It requires suturing. This procedure is usually performed in people who have scars or keratoconus. DSEAK is a transplant of the posterior (back) portion of the cornea. It does not usually require sutures and therefore results in less astigmatism. The visual recovery is faster, and there is a lower risk of rejection. The DSEAK procedure is usually performed in patients with corneal edema.