Corneal endothelial transplant

Endothelial transplant, or endothelial keratoplasty, is a surgical technique of corneal transplant selectiveIe only the diseased corneal endothelium is transplanted, preserving the rest of the cornea's layers healthy, which offers less trauma and better visual recovery. 

La cornea is made up of different layers and the corneal endothelium is the one that is deeper. The role of endothelium is to regulate the flow of aqueous humor that enters the cornea, contributing to its metabolism and maintain transparency of the cornea.

Corneal endothelial transplant

Endothelial transplant, or endothelial keratoplasty, is a surgical technique of corneal transplant selectiveIe only the diseased corneal endothelium is transplanted, preserving the rest of the cornea's layers healthy, which offers less trauma and better visual recovery. 

La cornea is made up of different layers and the corneal endothelium is the one that is deeper. The role of endothelium is to regulate the flow of aqueous humor that enters the cornea, contributing to its metabolism and maintain transparency of the cornea.

What is corneal endothelial transplant?

Endothelial transplantation, endothelial keratoplasty or lamellar cornea transplant posterior it is a surgical procedure that is performed to replace the diseased endothelium with a healthy one. When the endothelium does not work well, the aqueous humor enters and produces an edema of the cornea. Destructuring of the collagen layers occurs and the cornea becomes opaque, it no longer allows light to transmit into the eye and vision is lost.

Since the endothelium has no regenerative capacity, once the endothelium has been damaged, the cornea cannot recover its transparency and this is when a cornea transplant must be performed. Until now, the entire cornea was transplanted (penetrating transplant), but now we can selectively transplant the endothelium, respecting the rest of the healthy cornea. 

El endothelium transplantation has two technical variants, the DSAEK and DMEK. In both cases the endothelium is transplanted but in the DSAEK, the endothelium and Descemet's membrane, which serves as a base, while the DMEKis dissects the endothelium without the Descemet. Both techniques are very similar and with very similar results. 

Maybe the main advantage of the DSAEK is its lower complexity and lower complication rate, unlike DMEK, which is more complex and in greater danger of damaging the endothelial tissue that is transplanted. On the other hand, DMEK, when successful, the visual quality is somewhat better in most chaos. 

The criterion of which technique we choose, depends to a large degree of technical means that we have for the management de the tissues, surgeon's skill and status previous of the cornea.

When is this endothelial transplant indicated?

La Endothelial keratoplasty is performed when a patient has corneal endothelial problems. The endothelium is the deepest layer of the cornea and is responsible for keeping it nourished, allowing the aqueous humor to pass into the cornea to remove it later in order to prevent its accumulation.

The endothelial problems currently represent the 60% of corneal transplant cases.

La corneal opacity congenital, Fuchs endothelial dystrophy and posterior polymorphic dystrophy are the diseases more frequent with endothelial damage.

All the complications in cataract surgeryplatforms, congenital glaucoma and trauma in accidents affecting the eyes are the other major causes of endothelial damage.

corneal endothelial transplant

How is the endothelium transplant operation?

When talking about corneal or posterior lamellar endothelial transplantation, it can be assumed that we are dealing with a complicated and high-risk surgery.

Currently, ophthalmology has advanced so much that it is now possible to perform selective transplants such as endothelium transplants, with very high safety rates and calmly enter the operating room, as long as you have a expert surgeon or with a surgical center with the necessary technology.

 Let's meet next how DSAEK and DMEK are performed:

Before the intervention

Before starting the endothelial transplant, it is necessary for the patient to undergo a complete eye examination so that the doctor can examine the state of the ocular structure and determine if is a candidate or not a keratoplasty

La endothelial keratoplasty, in its two variants DSAEK and DMEK, you have a cataract-like surgical risk. Conclusion ambulatory surgeries which are done with sedation, with a surgical time of 30 to 45 minutes.

During the intervention

For take the DSAEK and the DMEK, the ophthalmologist will apply anesthetic drops local and a patient sedation.

With the eye anesthetized, the surgeon performs a microincision to remove damaged endothelium and after having dissected in the donor cornea, the endothelium-Descemet layer (DSAEK) or endothelium only (DMEK), introduces it into the eye, in the anterior chamber and unfolds it so that it is placed in the corresponding anatomical position. Does not require suturing, is fixed with the help of an expandable air or gas bubble that “irons” it and makes it easier for it to adhere to the internal plane of the cornea. 

The process takes about 40 minutes, 20 minutes to prepare the endothelium and 20 more minutes to implant it.

After the intervention

After surgery the patient wakes up and after a quick visual evaluation of the surgeon you can go home with a series of indications from the doctor and no need for hospital admission.

Postoperative endothelial transplant

El postoperative endothelial transplant (DMEK and DSAEK) its alot faster than other corneal transplant techniques, since only the affected tissue is transplanted and it is not necessary to perform sutures, which are complex and require more time. Therefore, the recovery process is much faster than other types of keratoplasty or other corneal surgeries.

After the intervention antibiotic and anti-inflammatory drops are prescribed as well as pain relievers in case of pain.

Endothelial transplant benefits

These two techniques of endothelial keratoplasty are currently the most revolutionary for endothelium transplantation, because it allows to selectively "change" the affected tissue, keeping the other layers of the cornea. 

La recuperación of the patient after DSAEK o DMEK es much faster than in a penetrating transplant, due to its selective nature and the non-need for sutures to fix it. Since DSAEK and DMEK act only on damaged layers, they offer best visual results and a much faster visual recovery.

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Corneal endothelial transplant
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Corneal endothelial transplant
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Corneal endothelial transplant is a type of selective corneal transplant where we only transplant the layers of the cornea that are damaged.
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Área Oftalmológica Avanzada
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