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Cornea Transplant Table

                    

	Partial Transplants (EK's) DSEK/DSAEK/DMEK	Full Transplants PK
Recovery Time	The "norm" is 4-6 months. Some are faster, and can see well in one month, some cannot see well over a year later.  Every patient is different!  Most patients who have these done will have to lie flat on their backs for anywhere from 4 hours up to 4 days after the surgery to keep the air bubble holding the graft securely in place,  as well as the normal bending/lifting restrictions.	The "norm" is 6-9 months.  Some are seeing well literally the day after surgery, some are not seeing well over a year later.  Every patient is different!  Patients who have these done will only have bending/lifting restrictions and no other limitations on them from immediately after the surgery onward.
Longevity, Rejection & attachment	In the beginning the graft is held in place by means of an air bubble pumped in during the surgery.  There appears to not be any proven data (not to mention consensus from drs) on how the graft attaches on these yet once the air bubble is gone other than that of the suction created by the pumping of the cells.  To date there is no definitive data on whether the graft ever fully permanently attaches "cell to cell"or not, or if the suction continues to be the primary form of attachment over time. In this instance we are using the term "permanent cell to cell attachment" to mean that in the event of having to redo the surgery the graft would need to be physically cut apart from the rest of the cornea.    This has led to a few drs cautioning their patients to be extra careful to not accidentally detach them by means of rubbing or pressure.  The durability of these grafts is,once again, something yet to be learned from these procedures; both in terms of durability of staying attached as well as of longevity of life of the graft.  The longevity of these are too new to know for sure yet.  Rejection percentages appear to be about the same as for the PK, but that data has not been fully studied yet to determine for sure at this point.  There have been some indications being noted of a "layer rejection" that is unlike a PK rejection not only in that it doesn't have the same recognizable symptoms as a PK rejection, but has absolutely no recognizable symptoms for the patient to be able to spot.  This is also something that has yet to be determined.	In the beginning the stitches are the primary form of attachment. (Note: said stitches are not seen when looking out of the eye, nor are they "felt" by the patient). During the healing process the cornea attaches permanently "cell to cell"- meaning that in the case of a redo of the surgery the graft would need to be surgically cut apart from the rest of the cornea again.  While some drs say the cornea is "weak" after one of these procedures, there have been numerous instances where full force airbags have struck group members shortly after having this surgery with no problems.  Although each surgery (of any kind) will weaken the eye more, the regrowth of the graft cell to cell just like the original tissue was attached has given these grafts durability and stability.  Anybody alive can have a cornea rupture, including those who had a cornea transplant of any kind, so caution should exist for everyone to "protect their eyes". It has been shown that in most cases (barring a rare uncorrectable rejection or rare graft failure, those done on fuchs'  dystrophy patients will generally last the entire lifetime of the recipient, no matter how many years that lifetime is.  "Graft failure" refers to a sudden, expected failure of the graft to react or respond and is not usually attributed to cell loss. There will always be a risk of rejection the rest of your life.  However, the earlier you get in to see the surgeon after the rejection begins the higher the odds of turning the rejection around and saving the transplant.  The odds are very low of transplants that are not "saved" in this method.
History	The first U.S. ones of this kind were done in the year: DSEK- very late 2003 or early 2004 DSAEK- very late 2005 or early 2006 DMEK- Mid 2009	The first successful one in the U.S. was done in 1905
Other problems	Up until very recently nobody thought to ask how, or if, the DSEK/DSAEK/DMEK ever completely permanently attaches "cell to cell" or not.   We have no idea what will be learned about them in the next few years that will be accepted knowledge later.  The DMEK is a much thinner graft than the other layer transplants, and the thinness of it is one of the major problems doing the surgery that they are experiencing right now.  They are having extreme difficulty getting it in and laying flat without any tearing of the tissue or other problems. The future is as of yet a blank slate in regards to longevity, complications, and just about everything  about these kinds of procedures due to how new they are.	Potential of astigmatism, which can USUALLY can be fixed via strategic stitch removal, glasses prescription, CRI procedure, RGP contact lenses, or Lasek surgery.  Only about 10% need something other than glasses prescription.
Post-Surgical Complications not related to the cornea	The problem that many have is "interface haze" which is blurriness and/or multiple vision.  With some this goes away in a period of a few months.  Others still have it more than 2 years later.  Since this procedure is so new there is no way as of yet to determine if it will ever fully go away or not, for those for whom it remained over a year after the surgery. Some other possible post-surgery complications that they are finding now are permanent pupil dilation and acute closed-angle glaucoma.  Of course there is also possibility of infection or inflammation as in any major surgery.	Nothing major other than usual risks of infection or inflammation as in any major surgery.
Studies Done (Note: it takes a min. of 10 years of doing a study in order to determine what will be "normal results" and what complications might occur, so that they can determine "fixes" for the problems, if there are any to find.)	Mayo Clinic started a scientific study on DLEK, but shortly into the study nobody was doing DLEK anymore and everyone was doing the DSEK/DSAEK, making any results they determine years from now on on this still on-going study obsolete.  If everyone within the next year+ changes to doing the DMEK (as is possible) any study now started on DSEK/DSAEK will then also be obsolete and another 10+ years will needed to do a DMEK study (if some other kind doesn't show up in the near future to make DMEK obsolete).  Keep in mind that the DSEK/DSAEK has only been done in very large numbers in the U.S. since late 2005 or early 2006.	Studies were done on these long before the time of the internet and the data is not available.  We know that this procedure has been done on literally millions of patients for over 100 years, with an average of 96-98% overall success rate.  These have been proven over that time to not have the disease return, and any complications are not only known, but solutions found for them long ago.  Keep in mind that these have been done successfully in the U.S. since 1905.
Cataracts	Many drs (not all) don't feel comfortable safely doing cataract surgery AFTER doing a DSEK/DSAEK.  Therefore most drs either do cataract surgery before the DSEK/DSAEK or at the same time, many of them doing it before (creating an additional trauma to the eye by having an additional surgery). If you don't have cataracts before you need a transplant this creates a problem.  Some drs do cataract surgery even when there are no cataracts. It's important to note that any dr who is doing cataract surgery has to either state to the insurance company a lie saying that you have cataracts that don't exist, or else have an urgent need for them due to some other condition such as an iris problem.  Doing cataract surgery without cataracts just so they don't have to do them later is not justifiable medically. If your dr schedules cataract surgery when you have no cataracts the patient needs to point this out to the insurance company.   If you don't have cataracts other drs refuse to do the DSEK/DSAEK until you have cataracts.    We have no idea regarding cataract surgery with a DMEK, since these are so new that a full year is just beginning to go by since the first few were done in the U.S.	There is no problem with doing cataract surgery either before the full transplant, the same time as the transplant, OR after the transplant.  Therefore, if you do not have cataracts by the time you need a transplant, there is absolutely no problem in waiting and doing the cataract surgery later.  This is a highly successful alternative for patients whose fuchs' dystrophy is advanced enough to need a cornea transplant, but have no cataracts yet.
Corneal Blisters and/or Map-Dot	If you have scarring in the epithelium or sclera due having had Corneal Blisters or Map-Dot, having a DSEK/DSAEK/DMEK will not remove the resultant scar tissue.  The drs then do a 2nd procedure to remove the scar tissue with a laser (unless they do this procedure as part of the actual transplant surgery).  Just as if you are using a laser to remove scar tissue in any other part of your body it will leave residual material and does not leave a nice clean cornea.  In addition, it does not remove the disease Map-Dot, so if you have Map-Dot additional scarring is going to continue to occur over time, and the laser work will continue to need to be redone.	If you have scarring in the epithelium or sclera due to having had Corneal Blisters or Map-Dot having a full transplant will fully remove not only the scar tissue, leaving the patient with a graft that has clear and clean never having had any scar tissue, but it also fully removes the Map-Dot so that it no longer will recur.

  Please note:  With DSEK/DSAEK/DMEK all the work is done INSIDE the eye.  With full transplants all the transplant surgery is done OUTSIDE of the eye. 

For more about Full and Partial Cornea Transplants, please read our Cornea Transplant Frequently Asked Questions Page at:

http://files.fuchssupport.info/Cornea_Transplant_FAQ.html

For more Full and Partial Cornea Transplant Comparisons:

http://files.fuchssupport.info/T_Comparisons.html

For more questions to ask your dr before having a cornea transplant of any kind:
http://dr.fuchssupport.info/T_Questions.html

For Post-Partial-Transplant Dr Questions:

http://dr.fuchssupport.info/postpartial_questions.html