Cornea Surgery

About Corneal Surgery

Corneal transplant surgeons at Cleveland Clinic’s Cole Eye Institute perform state-of-the-art procedures for numerous conditions that distort or cloud the normally transparent cornea. Traditional full-thickness procedures, also known as penetrating keratoplasty (PK), made up the majority of the grafts performed a decade ago. Cole Eye Institute surgeons have made several key contributions to the advancement of lamellar corneal transplants, which are partial-thickness procedures in which only the diseased portion of the cornea is replaced. Using a procedure called Descemet stripping automated endothelial keratoplasty (DSAEK), surgeons selectively transplant the endothelium for conditions such as Fuchs endothelial dystrophy and pseudophakic bullous keratopathy. These patients experience faster visual recovery and more stable and predictable refractive outcomes than do patients treated with traditional PK. The institute also has several years of experience with Descemet membrane endothelial keratoplasty (DMEK), a procedure that involves placement of an even thinner graft than with DSAEK. During 2018, 55 PKs, 72 DSAEKs, and 87 DMEKs were performed. This is consistent with an international trend toward less invasive corneal transplant procedures for endothelial disease. After DSAEK or DMEK, 99.4% of grafts remained clear at 3 to 12 months.

Corneal transplant surgeons at the institute are leaders in the investigation and clinical use of integrated intraoperative optical coherence tomography (iOCT), a major real-time imaging advance that allows better identification of surgical endpoints and improved outcomes of lamellar transplant surgeries such as DSAEK, DMEK and deep anterior lamellar keratoplasty (DALK). The low reoperation rate on endothelial transplants in 2018, which included a significant number of DMEK procedures historically prone to higher dislocation rates, partially reflects the integration of this technology into routine use at Cole Eye Institute. The observations gained from large-scale implementation of iOCT are fueling other innovations in surgical instrumentation and technique, all with the goal of optimizing surgical safety and patient outcomes.

Corneal Surgeries by Procedure (N = 282)

2018

DALK = deep anterior lamellar keratoplasty, DMEK = Descemet membrane endothelial keratoplasty, DSAEK = Descemet stripping automated endothelial keratoplasty, Other = pterygium excision, superficial keratectomy, band keratopathy, Boston keratoprosthesis, corneal epithelium debridement, and amniotic membrane grafts, PK = penetrating keratoplasty

After DSAEK or DMEK, 99.4% of grafts remained clear at 3 to 12 months. For PK patients, 100% of grafts remained clear at 3 to 12 months. Institute surgeons also performed DALK for corneal scars and keratoconus; in this procedure, the recipient’s anterior cornea is replaced but the patient’s healthy endothelium is retained, eliminating the risk of endothelial rejection.

Highly specialized transplants are performed in smaller numbers for uncommon sight-threatening corneal conditions. For end-stage corneal disease in patients who were poor candidates for other forms of transplantation, synthetic corneas (Boston keratoprostheses) were implanted to allow them to regain some visual function.