What is a Cornea Specialist?
A cornea specialist is an ophthalmologist who has undergone additional training and study of the cornea structure, diseases, and related surgeries. Having an experienced cornea specialist ophthalmologist can increase the chances of a successful cornea surgery outcome.
What is a Corneal Transplant?
A corneal transplant, also known as a corneal graft, or as penetrating keratoplasty, involves the removal of the central portion (called a button) of the diseased cornea and replacing it with a matched donor button of the cornea. Corneal grafts are performed on patients with damaged or scarred corneas that prevent acceptable vision. This may be due to corneal scarring from disease or trauma.
Deciding When to Have a Corneal Transplant
A common indication for keratoplasty is keratoconus. The eye-care practitioner must decide when to recommend keratoplasty for the keratoconic patient. This is often not a simple, straight-forward decision. Keratoplasty for keratoconus is highly successful; however, there is a long recovery period and a risk of severe ocular complications. A number of factors must be considered in deciding when to do a keratoplasty. One of the most important is the patient’s functional vision. If the best acuity with their contact lenses prevents them from doing their job or carrying out their normal activities, a transplant must be considered. The actual measured visual acuity may be quite different for different patients. One patient may find that he/she can not do their job with 20/30 acuity while another patient may be very satisfied with 20/60 acuity.
Very careful contact lens fittings are necessary before recommending a corneal transplant. One study found that 69% of keratoconics, most referred for transplant, could be successfully fit with contact lenses if special lens designs were used. Thus, prior to transplant, every effort should be made to optimally fit the patient with contact lenses, especially if there is not significant corneal scarring affecting vision. However, a few patients become intolerant to contact lenses and require a transplant earlier than otherwise would be necessary. If the patient has a large area of thinning, a very decentered cone or significant blood vessel growth into the usually clear cornea, called neovascularization, a transplant may be performed earlier than otherwise indicated by the visual performance, as these factors may require a larger than normal transplant button size and/or increase the chance of rejection if allowed to advance too far.
No-Stitch surgery is possible by use of modern tissue adhesive. Often composed of clotting proteins from human blood the tissue adhesive allows the surgeon to secure an autograft in a short amount of time. Once the abnormal tissue is removed a thin graft of normal tissue is used to replace the damaged area.
Pterygium can be quite common in Maryland. If you think that you may be in the process of developing this type of eye growth please contact us immediately so that we can properly diagnose and treat the problem before it worsens. Our Baltimore pterygium eye doctors are available for an appointment or consultation regarding your specific visual situation with pterygium.
What is Pterygium?
Pterygium is an abnormal superficial growth of the conjunctiva that extends from the corner of the eye near the center of the eye. The pterygium can vary in appearance. It can range from a small hard to see tissue mass to a large red and very noticeable growth. Because pterygium varies in appearance, it may be yellow, gray, white, pink, red, or even colorless. It may even have blood vessels. If you think you might be experiencing the growth of such tissue, please be sure to contact our practice for an immediate exam. If you are seeking a surgeon for removal of pterygium, call us. Most patients with pterygium contact ophthalmologists either due to concern regarding the appearance of the lesion or because the lesion is irritating the eye or it is adversely affecting vision.
Penetrating Keratoplasty or traditional Full-thickness corneal transplant is a surgical procedure where the central two-third of the diseased cornea is removed and replaced with a clear, healthy donor tissue which is secured in place with sutures. A PKP requires a full year to heal. Attaining maximum visual recovery may require a contact lens if the surface of the new cornea is somewhat irregular.
Patients with a PKP must protect the eye indefinitely and avoid injury as such event may split the incision open. More advanced types of Corneal transplants such as Endothelial Keratoplasty (DSAEK) or anterior lamellar Keratoplasty (DALK) Target the diseased layer of the cornea making these procedures more selective.
These newer techniques give the added advantage of faster healing, less restriction in activity, and improved integrity of the eyeball with reduced risk of injury to the eye.
DSAEK / DSAEK Cornea Surgery
Fuchs’ Dystrophy patients are the primary group of patients needing a DSAEK procedure. Fuchs’ endothelial dystrophy (FED) is a degenerative disorder of the corneal endothelium leading to corneal edema and loss of vision. Patients first receive a full evaluation and testing at Dulaney Eye Institute so that our doctors can best determine the patient’s treatment options, including the need for DSAEK surgery. One week prior to surgery the staff at our Baltimore area ophthalmology practice begins the process of procuring donor corneal tissue in preparation for the patient’s DSAEK surgery and schedules all appropriate operating room time at the surgical facility.
On the day of surgery, the patient will arrive at the surgery center approximately one hour prior to surgery for preparation. The patient must not eat anything after midnight the day before surgery and will begin pre-operative medications three days prior to surgery as instructed. Prior to the patient’s surgery, the surgeon will prepare for surgery by determining the type of tissue to be used and selecting the technique needed to ensure the best surgical outcomes possible. After the approximately one hour surgery, the patient must lie flat on their back so the air can push up into the cornea and hold the new tissue in position. Once the tissue sticks to the cornea, it will begin to function and pump the water out of the cornea, clearing vision. Vision improves fairly rapidly, with final visual results obtained in approximately 1-6 months after surgery.