Corneal Transplant Surgery

David Anderson performs a wide range of specialist surgical procedures to the cornea including the selective corneal transplant surgeries DSEK, PK and DALK. 

300+ 5-Star Patient Reviews:

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Corneal Transplant Surgery

The cornea is the transparent dome of tissue that forms the front protective coat of the eye. It is responsible for the majority of the focusing power of the eye. Any condition that reduces the transparency of the cornea will result in loss of vision. 

David Anderson completed two full Fellowships in corneal surgery at Moorfields Eye Hospital in London and a one year post-Doctorate at Bascom Palmer Eye Institute in Miami as a TFC Frost Scholar, studying reconstructive techniques including the use of amniotic membrane for complex conditions. He has written and presented extensively on the subjects and has led the Corneal Fellowship programme at University Hospital Southampton for over a decade.

Corneal Transplant Animation

Corneal Transplant Surgery Types

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Two eyes following DSEK corneal transplant surgery

Corneal transplant surgery involves selectively replacing that part of the cornea damaged by disease with healthy tissue from a donor eye e.g. the endothelium in Fuchs’ Dystrophy, or the stroma in Keratoconus. In some cases, all layers of the cornea require replacement by full thickness or Penetrating Keratoplasty (PK).

Full thickness or Penetrating keratoplasty (PK). You will undergo a thorough ophthalmic examination including advanced scanning or mapping of your cornea using the Pentacam HR or Zeiss Atlas system. You will then be in a position to make a fully informed decision as to which type of procedure will be the best for you. David Anderson introduced DSEK surgery to University Hospital Southampton in 2007 and has been at the forefront of corneal surgery since his appointment as Consultant in 2003. 

Descemet Stripping Endothelial Keratoplasty

Descemet Stripping Endothelial Keratoplasty (DSEK) is a procedure designed to replace corneal endothelial cells lost through genetic disease e.g. Fuchs’ Dystrophy or following trauma from previous surgery i.e. pseudophakic bullous keratopathy.

Further information and guidance is also available on the NICE website here.

DESK Cornea Animation

During DSEK the damaged inner layer of endothelial cells along with its supporting tissue, Descemet’s Membrane, is removed from the eye through a small entry port millimeters in size. A new layer of cells along with its supporting membrane as a small disc between 8-9mm in diameter and around a tenth of a millimeter thick is precisely created from a donor cornea. This disc is rolled up and then using a special injector, inserted into the eye through the same entry port and carefully unrolled and positioned against the underside of the cornea. An air bubble is used to help press it in place. The cells begin to pump fluid from the swollen cornea immediately which starts to stick the new sheet of cells into place. The small air bubble is left in the eye to support the new sheet whilst they continue to heal firmly into place, this air bubble will dissolve naturally in the eye over the next few days. Rather than the 16 stiches required to hold a PK in position, only one stich is required and this is usually removed at the second follow up visit a month or so later. DSEK has important advantages over PK for conditions that cause endothelial failure; the eye is more stable, quicker to recover vision, more resistant to injury and the change in spectacle prescription is far lower in turn speeding the recovery of functional vision. For these reasons and others, selective endothelial replacement surgery has become the ‘gold standard’ to treat causes of endothelial failure. 

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OCT scan showing cross section through a cornea following DSEK. The layer of transplanted tissue is seen on the underside and measures between 61 and 69 microns thick.

Surgery

Surgery typically will take place under local anaesthesia although general anaesthesia can also be used. On the day of your procedure you will be admitted to a private room with an en-suite facility. Following administration of your anaesthetic the procedure will typically take around 40 minutes to complete. On return to your room we will ask you to lay relatively flat looking up at the ceiling for some hours so that the air bubble can continue to float upwards and push against the new layer of cells. You can sit up or stand for brief periods of time e.g. to take meals but then we will ask you to lay flay again . Your vision will be blurry because of the air bubble but this will dissolve naturally over the next few days. Most people choose to stay overnight and return home the next day although you do not have to. 

Aftercare

Your eye may feel a little gritty or achy immediately following surgery but it should not be painful and we will place a clear shield over the eye at the time of surgery so that it is protected. We will ask you to use eyedrops frequently in the immediate post-operative period, then slowly reduce the frequency of drops over the next months, you will not need to take anti-rejection tablets unless there are exceptional circumstances. For the first day or two we ask you to lay flat as far as possible whilst the air bubble is still present. Your vision will be blurry although most people are not aware of seeing the air bubble, we ask you to arrange transport home from the hospital as you should not drive. We recommend that you avoid strenuous lifting or activity for the next few weeks following surgery and take care to avoid injury e.g. wear eye protection if gardening or playing sports like badminton or squash. As the new layer of endothelial cells continue to clear your cornea your vision will improve. 

FAQs

Corneal transplants are the most successful solid tissue transplant and rejection or failure of the donor material when surgery is otherwise routine is rare. Around 60-90% of transplants in the best circumstances e.g. Fuchs’ dystrophy will survive 5 years following surgery. We report a survival rate of 100% at 2 years from national audit. The longest outcomes studied to date are from the Australian Corneal Graft Registry and show that between 60 and 90% of transplants are functional at 10 years.

 

Rejection can occur however, so we ask you to use anti-rejection eyedrops and to report any symptoms of rejection immediately.

Yes, if a DSEK rejects or fails it can be removed and the procedure repeated. As surgery takes place through small entry ports, recovery is much faster than traditional PK so we are now able to offer DSEK within PK in cases where full thickness transplants have failed.

No, your eye will be uncomfortable in the immediate post-operative period only but you should not require anything other than mild pain relief.

All operations carry the risk of complications whether from the anaesthetic, surgical procedure itself or subsequent medical procedures but these risks remain low. In addition to the risks of transplant rejection or failure, DSEK is an intra-ocular operation so although low, the risks of this type of surgery include the risks of any procedure performed inside the eye and include: infection, macula oedema, raised pressure of the eye and retinal detachment.

Penetrating Keratoplasty

Penetrating Keratoplasty (PK) surgery was first performed in 1905 and so has been a very well characterized procedure. PK involves replacing the full thickness of the damaged cornea with a healthy disc of tissue from a donor cornea around 8mm in diameter. The new cornea is held in place with fine stitches, each around a quarter the diameter of a human hair and buried within the cornea so that they cannot be felt. As the cornea contains no blood vessels, healing between the donor and recipient cornea is slow and takes many months to years so it is important to avoid injury to the new cornea. 

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This image shows an eye following PK with 16 radial black stitches in place securing the new transplant.

Surgery

Surgery typically takes place under general anaesthesia. The procedure will typically take around one hour and afterwards your eye will feel slightly scratchy but otherwise comfortable. You will not need to stay in hospital overnight but we will arrange a follow up review within the first week following surgery.  

Aftercare

We will ask you to use drops very frequently for the next few days, then slowly reduce the frequency over many months. You can return to normal activities but must be careful to avoid injuring your eye. We will ask you to wear protective goggles overnight. You will have blurred vision immediately following surgery and vision will slowly improve over the following weeks to months. You will need to arrange transport home from the hospital. 

FAQs

Corneal transplants are the most successful solid tissue transplant and rejection or failure of the donor material when surgery is otherwise routine is rare. Similar to DSEK around 95% of transplants will survive 5 years following surgery in the best cases e.g. Keratoconus. The longest outcomes studied to date are from the Australian Corneal Graft Registry and show that between 60 and 90% of transplants are functional at 10 years. We have reported long term outcome data for emergency corneal transplants. Rejection can occur however, so we ask you to use anti-rejection eyedrops and to report any symptoms of rejection immediately.

Yes, if a PK rejects or fails it can be removed and the procedure repeated. Nowadays, we tend not to repeat the entire PK as it is usually the inner layer or endothelium which is affected. This allows us to perform a DSEK procedure within the existing PK, this allows for a faster recovery.

No, your eye will be uncomfortable in the immediate post-operative period only but you should not require anything other than mild pain relief.

All operations carry the risk of complications whether from the anaesthetic, surgical procedure itself or subsequent medical procedures but these risks remain low. In addition to the risks of transplant rejection or failure, PK is an intra-ocular operation so although low, the risks of this type of surgery include the risks of any procedure performed inside the eye and include: infection, macula oedema, raised pressure of the eye and retinal detachment.

Deep Anterior Lamellar Keratoplasty (DALK)

Deep anterior lamellar keratoplasty (DALK) is a variation of PK where instead of all layers of the cornea replaced with a disc of donor tissue, the epithelium and stroma are replaced leaving the original endothelium. 

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This is an image of an eye following a DALK procedure, one single nylon stich with 16 parts can be seen holding the new transplant in place.

DALK is particularly useful for treating conditions which affect only the front layers of the cornea, too deep for laser resurfacing. We perform DALK using two methods depending on the circumstances: traditional DALK and big bubble DALK (bb-DALK).

DALK was pioneered as a technique by Dr Gerrit Melles a Dutch Ophthalmologist practicing in Rotterdam. David visited Gerritt in Rotterdam to train in this technique and has been performing DALK from 2000 to the present time. 

Your DALK procedure explained

The process of DALK including the surgery, aftercare and results are almost identical to PK (see section above). The principle advantages of DALK over PK are that rejection is less likely and because the innermost layer of the cornea is left intact the strength of the wound is higher. The is however, an interface between the donor cornea and the recipient cornea which can cause increased light scatter so final visual performance may be less clear tan with PK.

In 2015 we published a definitive review of visual quality following corneal transplantation surgery for Survey of Ophthalmology one of the highest impact ophthalmic science journals. The review can be found here

5-Star Corneal Surgery Reviews

Garth
A great outcome after having problems…
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A great outcome after having problems with my right eye for 18 months. The DESC operaration, on 25th March, at the Wessx Nuffield went very smoothly, carried out by a very professional and competent team, lead by David Anderson. This was followed by excellent aftercare by the Staff of The Wessex Nuffield. Within 48 hours, my clarity of vision improved greatly and has continued to improve. I am now back excercising on my my cross-trainer and walking daily. I have no hesitation in recommending Anderson Eye Care Ltd.
Trev
Heartfelt thanks
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David Anderson and his team performed miracles on my right eye last year: a cataract followed by an eye graft to correct the problems caused by Fuchs Dystrophy. My vision has improved immeasurably since the treatment and I've already had follow-up appointments with David to check progress. Im advised I can expect still more improvement over the coming months and I couldn't be more pleased! The quality of care I received from David Anderson, his team, and the Nuffield nursing staff has been exemplary at all times and I extend my heartfelt thanks 🙂 Trevor Pape
Mike
DSEK surgery
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I underwent lens replacement followed by DSEK surgery during 2013 / 2014. All procedures were undertaken by David Anderson. Given that this involved intrusive surgery into both my eyes from the very first consultation my early concerns were laid to rest with details of the procedure clearly set out in a clear and confident manner by David. This made the decision to go ahead with the procedure very easy Each of the following 4 operations went extremely smoothly with the benefits of the DSEK very much life changing almost immediately after surgery. The follow up consultations were equally through. At all stages of the process I have found David and his team to be professional considerate and reassuring and have no qualms in reassuring any one following in my footsteps to choose David as their eye consultant
Dr Eileen
Dsek surgery…
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Three weeks ago I underwent Dsek surgery to improve my eyesight which was becoming hazy due to Fuschs dystrophy. I approached the operation with some trepidation but there was no need for fear in David Anderson’s capable hands. I was cared for with kindness throughout by the team and even lying on my back for a short time post op soon passed as I imagined the air bubble acting as a little roller smoothing the cells onto the cornea. I was able to drive the car the following day and whilst making sure my regime of eye drops is adhered to, life continues as normal except now with clearer eyesight.
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