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The endothelial keratoplasty technique is used to replace the inner layer of the cornea with the inner layer of a donor cornea through a small incision (opening).
Benefits of endothelial keratoplasty
Improved vision. Approximately 75% of transplant patients have enough vision to drive. Recovery can take up to six months.
Risks with endothelial keratoplasty
Rare but serious complications:
Infections that can affect the eyesight (1 in 1,000).
Severe bleeding that causes loss of vision.
Cornea transplant rejection. In the two years after a transplant, one in six patients may experience a rejection. This often occurs because the patient stops taking the anti-rejection medication without advice from their doctor. However, rejection remains a possibility throughout the patient's life.
Glaucoma. This complication can usually be controlled by applying drops to try to lower the intraocular pressure, but it may occasionally require surgery.
Transplant dislocation. About 10% of endothelial transplants become dislocated and need to be repositioned in the operating room by introducing an air bubble.
Cataracts. These can be operated on by inserting an intraocular lens.
Advantages of endothelial keratoplasty over penetrating keratoplasty
Fewer stitches, meaning that the normal shape of the cornea is preserved and the patient is less dependent on glasses or contact lenses.
A smaller wound, so there are fewer wound related complications, such as leaks or rupture of the wound after an accidental bump.
Less chance of rejection as less tissue is transplanted.
Surgery: endothelial keratoplasty
Generally, the operation is performed under local anaesthetic and lasts approximately an hour. The damaged endothelium is removed through a small incision (opening) and replaced with an 8 mm disc from the donor’s endothelium. It is inserted and pressed into position against the back of the cornea with an air bubble.
You must rest for an hour after the operation, and also during the following 24-hour period, lying in a face-up position to ensure the transplant adheres to the endothelium at the back of the cornea (by means of an air bubble that is reabsorbed in 24-48 hours). Usually only two stitches (or none at all) are used to close the incision.
The patient is discharged the same day. The next day the surgeon follows up on the procedure, and then a week later, to make sure the transplant is in the proper position.
In the first year, the patient will need approximately six visits and, if they work, it is advised that they take a two-week sick leave.
Throughout the first year, the patient has to take anti-rejection eye drops and, in some cases, one drop a day is recommended forever. The stitches are removed between the second and third month after surgery.