Penetrating Keratoplasty: Advantages and Disadvantages
Transplanting simply Descemet's layer and the endothelium saves the foremost corneal structures. Here's the means by which to begin. As of late, a becoming number of corneal specialists have dismissed from penetrating keratoplasty (PK) as their favored method for corneal transplantation for the evidence of corneal endothelial brokenness for a more current strategy said to hold huge similar points of interest, Descemet's-stripping automated endothelial keratoplasty (DSAEK).
It consequently makes sense that a technique that targets just Descemet's layer and the endothelium addresses the boss wellspring of visual misfortune in these conditions while saving whatever is left of the cornea and safeguarding its typical shape. The accompanying discourse offers an orderly manual for this energizing new system.
Indeed the most rich and creative new corneal surgical strategies have their upsides and downsides, and DSAEK is no special case.
Advantages:
Maybe boss among DSAEK's favorable circumstances is the quick visual restoration -- on the request of weeks versus far more after penetrating keratoplasty -- encouraged by leaving the front-surface corneal shape generally unscathed. (A few specialists support the utilization of one to three sutures, while others go sutureless.) You accordingly wind up with negligible foremost topographic change. The change in anticipated post-agent refractive mistake in like manner is insignificant, normally a little hyperopic movement (1.0 to 1.5 diopters).
The complete or relative absence of sutures additionally takes out the danger of suture-related difficulties, including vascularization that can prompt allograft dismissal. A generally in place globe opposes injury significantly more versatility than in eyes taking after PK (Figure 2).
Upper right: same patient one day post DSAEK with no sutures and a 30% lingering air bubble.
Lower: Same patient one month post DSAEK with clear cornea.
Disadvantages:
Regularly, any new surgical strategy, for example, DSAEK involves an expectation to absorb information. It's likewise characteristic to anticipate that some safety will change, especially among the individuals who have performed penetrating keratoplasty for a long time and are open to doing so.
One of the testing parts of DSAEK is the planning of the benefactor tissue. While a few specialists like to set up the tissue them. In DSAEK, the giver tissue incorporates Descemet's layer and the endothelium together with 80-150 microns of bearer benefactor stromal issue that encourages control of the union.
The danger of catch disengagement, since the joining itself is not held by any sutures, is an alternate potential intricacy. An effective methodology obliges that the giver catch stick to the cornea's back surface. If not, the cornea will stay swollen and the specialist should then establishment measures to make the joining. Various occasions can result in benefactor catch separation (Figures 3 & 4). See Table 1 for normal reasons for catch disengagement.
A last potential weakness needs to do with the lamellar interface. Having two segments of follower tissue (the giver and host) -- rather than the one bit of a full thickness transplant -- welcomes some level of visual trade off, on the request of one to two lines of Snellen acuity. But this commonly wins just for the short term, a matter of weeks to months. Last visual sharpness of 20/20 may be accomplished one to two years postoperatively. Of discriminating essentialness is that most patients lean toward a 20/25 result with insignificant ametropia/refractive slip to 20/20 with solid exhibition or contact lens correction.
It consequently makes sense that a technique that targets just Descemet's layer and the endothelium addresses the boss wellspring of visual misfortune in these conditions while saving whatever is left of the cornea and safeguarding its typical shape. The accompanying discourse offers an orderly manual for this energizing new system.
Indeed the most rich and creative new corneal surgical strategies have their upsides and downsides, and DSAEK is no special case.
Advantages:
Maybe boss among DSAEK's favorable circumstances is the quick visual restoration -- on the request of weeks versus far more after penetrating keratoplasty -- encouraged by leaving the front-surface corneal shape generally unscathed. (A few specialists support the utilization of one to three sutures, while others go sutureless.) You accordingly wind up with negligible foremost topographic change. The change in anticipated post-agent refractive mistake in like manner is insignificant, normally a little hyperopic movement (1.0 to 1.5 diopters).
The complete or relative absence of sutures additionally takes out the danger of suture-related difficulties, including vascularization that can prompt allograft dismissal. A generally in place globe opposes injury significantly more versatility than in eyes taking after PK (Figure 2).
Upper right: same patient one day post DSAEK with no sutures and a 30% lingering air bubble.
Lower: Same patient one month post DSAEK with clear cornea.
Disadvantages:
Regularly, any new surgical strategy, for example, DSAEK involves an expectation to absorb information. It's likewise characteristic to anticipate that some safety will change, especially among the individuals who have performed penetrating keratoplasty for a long time and are open to doing so.
One of the testing parts of DSAEK is the planning of the benefactor tissue. While a few specialists like to set up the tissue them. In DSAEK, the giver tissue incorporates Descemet's layer and the endothelium together with 80-150 microns of bearer benefactor stromal issue that encourages control of the union.
The danger of catch disengagement, since the joining itself is not held by any sutures, is an alternate potential intricacy. An effective methodology obliges that the giver catch stick to the cornea's back surface. If not, the cornea will stay swollen and the specialist should then establishment measures to make the joining. Various occasions can result in benefactor catch separation (Figures 3 & 4). See Table 1 for normal reasons for catch disengagement.
A last potential weakness needs to do with the lamellar interface. Having two segments of follower tissue (the giver and host) -- rather than the one bit of a full thickness transplant -- welcomes some level of visual trade off, on the request of one to two lines of Snellen acuity. But this commonly wins just for the short term, a matter of weeks to months. Last visual sharpness of 20/20 may be accomplished one to two years postoperatively. Of discriminating essentialness is that most patients lean toward a 20/25 result with insignificant ametropia/refractive slip to 20/20 with solid exhibition or contact lens correction.
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