ALK and DALK
Corneal Transplant Procedures
A penetrating keratoplasty is full-thickness corneal transplant, and was first developed more than 100 years ago. In this procedure, an entire donor cornea is transplanted to replace a patient’s central cornea.
Traditional corneal transplant surgery has about a 90% success rate, and the rate of rejection is about 8%.
Occasionally, there are problems with sutures which can come loose, cause infections, or cause astigmatism. The astigmatism in this procedure can be significant enough that eyeglasses alone won’t give adequate vision. These patients may ultimately require contact lenses or additional surgery to reduce or eliminate the astigmatism. Because the wound is full-thickness, the wound is not as strong as normal and may open from mild trauma, even several years after the surgery. Full visual recovery can take 6 to 12 months. Finally after five years almost 70% of the transplanted endothelial cells are lost and in some cases a repeated transplant is required due to endothelial failure.
We now proudly offer the modern corneal transplantation procedures such as ALK, DALK and DSAEK that have replaced in most cases the previously performed penetrating keratoplasty and its inherent problems.
Doctor Salomon Esquenazi is the author of many peer-reviewed papers on lamellar corneal transplantation techniques and is a consistent lecturer on its benefits and results in national and international symposiums such as the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery.
A DSAEK procedure is a modern microsurgical corneal transplantation procedure that replaces only the failing endothelial layer of cells. A very thin layer of tissue containing the endothelial cell layer, obtained from a cadaver eye, is attached to the back surface of the patient’s cornea. This new technique constitutes a significant improvement over the previous penetrating keratoplasty procedures. The surgery is performed under local anesthesia, involves a smaller surgical incision that requires one or two stitches, heals faster and more reliably with minimal induction of astigmatism and provides a faster visual recovery.
The smaller wound is more stable and less likely to break open from trauma. The maximum visual acuity is reached between 3 to 4 months following the procedure. The procedure involves replacing only the failing layer of the cornea leaving the rest of the cornea intact. This allows a greater structural integrity and may reduce the incidence of rejection. It is like changing the wallpaper instead of the whole wall. If the DSAEK operation fails, the operation can be repeated with another button of donor endothelium. If the DSAEK fails, either after one or multiple attempts, a traditional corneal transplant operation can be performed.
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ORBSCAN Diagnostic Tool
An anterior lamellar keratoplasty is a modern advanced procedure that replaces the scarred anterior stroma. If less that the superficial 50% of the cornea is damaged an anterior keratoplasty (ALK) may be performed to replace the damaged tissue and restore the best visual potential of the patient. However if all the stroma is involved a deep anterior lamellar keratoplasty (DALK), that replaced the full thickness stroma is performed. Both procedures require significant surgical skills and are performed under local anesthesia. Because it is a lamellar graft there is no entry into the eyeball and consequently there is less risk of intraocular infections and cataract formation.
Finally, because the innermost endothelial layer of cells is preserved, the risk of endothelial cell loss and graft rejection is greatly minimized.
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