News in cornea transplant surgery

The cornea is the anterior transparent structure of the eye. Thanks to it, it is possible for light to pass through the eye and transmit images. However, there are several pathologies that can alter the function of the cornea as its opacification or deformation. In the case of deformation of the cornea, it is produced by keratoconus, a disease with a high incidence in the Canarian community. Keratoconus, when it is very advanced, can only be treated through corneal transplant surgery.

What's new in the cornea transplant?

The most modern corneal transplant techniques have turned this surgery into a less invasive, less aggressive surgery. We are talking about lamellar transplants where it is not necessary to remove the entire structure of the cornea. We no longer have to transplant the entire cornea of ​​another donor in the recipient but we are going to remove the most anterior part, the anterior cornea, doing what we call a lamellar transplant.

This makes the postoperative recovery much faster but it has also greatly improved the effectiveness in terms of possible rejections that have always been relatively low. In fact, the current risk of a possible rejection does not reach 10%.

There are also endothelial transplants that are those in which what does not work of the cornea is the endothelium that is the innermost layer. In these cases it is only necessary to perform a replacement of the endothelium while preserving the rest of the corneal structure. Within the group of lamellar keratoplasties, endothelial replacement techniques are the most recently developed.

In a general way, we would say that the main indication of a corneal endothelium transplant would be any patient with endothelial dysfunction that produces visual alterations and / or discomforts considerable enough to propose a definitive surgical treatment. Those affected by endothelial dystrophies, mainly with Fuchs' dystrophy, are the largest group of patients with this pathology.

Is it necessary to carry out a new transplant in case of rejection?

Many of these rejections do not end in a new transplant but we can stop it with the modern medication that we now have in patients who undergo a cornea transplant. The most important thing is that from that number of low rejections that we currently have with full penetrating transplants in the cornea we have been able to reduce the effectiveness of this technique by performing only anterior lamellar transplants in the advanced treatment of keratoconus.

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