No-stitch Cornea Transplantation
By Satya Reddy, MD
Corneal guttata is a condition that affects one in 1,000 people in which the inside layer of cells (the endothelium) of the cornea malfunction (the cornea is the clear dome that comprises the front surface of the eye and consists of three basic layers). In its late stages, the condition is termed: Fuchs dystrophy. Coined by Dr. Ernst Fuchs in the early 1900s. Once corneal guttata have progressed to the stage described as Fuchs dystrophy, the patient’s vision is frequently affected. Patients typically notice the following symptoms:
- Hazy vision in the morning, clearing by mid-day
- Poor vision in low-light conditions such as driving at dusk
- General fogginess that doesn’t improve with glasses
- Intractable glare
- Difficultly reading in spite of using progressively-stronger reading glasses
Frequently, these patients require an evaluation by a cornea specialist for both diagnosis and treatment. Many of these patients require surgical intervention to recover vision and improve their quality of life. Until recently, the only option available was a full-thickness cornea transplant, also known as a penetrating keratoplasty (PKP). While cornea transplant surgery is the most successful human transplant surgery performed, recovery time can range from six months to two years. Also, patients frequently need to wear custom contact lenses and suffer from dry eye. In spite of these compromises, 25,000 patients still elect to have surgery every year.
In the last few years, I was one of a group of ophthalmologists that developed a new technique of cornea transplantation called Descemets’ Stripping Endothelial Keratoplasty (DSEK). In DSEK, the surgeon removes only the dysfunctional inside layer of cells (the endothelium) and transplants a new layer of cells, leaving the rest of the patient’s own cornea intact. The recovery time is usually under three months, and frequently less than a month. Most patients can wear glasses with a relatively mild prescription. In PKP surgery, the patient would require up to 18 stitches. DSEK surgery requires typically only two stitches and is frequently referred to as “No-Stitch Cornea Transplant,” as the transplanted tissue requires no stitches. The whole surgery is performed through a ¼-inch incision on the edge of the cornea and the patients are in the hospital for only three to four hours. The patient experience is very similar to cataract surgery. Because DSEK allows faster and more predictable recovery, patients afflicted with Fuchs dystrophy are electing to have surgery earlier in the disease process and resume the lifestyle to which they have become accustomed, with fewer compromises.
Satya Reddy, MD, is with Louisiana Cornea Specialists