Corneal Surgery

Corneal surgery encompasses a range of advanced procedures aimed at improving vision caused by problems with the cornea. This may involve reshaping, replacing, or reinforcing the cornea.

Corneal transplantation

Corneal transplant (graft) is a highly specialized surgery that can only be performed by an ophthalmologist, who has had additional years of subspeciality training in corneal surgery.

Dr Season Yeung at Eastwood Eye Specialists is a corneal specialist experienced in performing all types of corneal transplantations, including endothelial keratoplasty (DSAEK, DMEK), deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK). Corneal transplantation may be required for a variety of corneal diseases when they reach a severe stage, including Fuchs’ endothelial keratoplasty and advanced keratoconus. Dr Yeung offers corneal surgery both in private hospitals and at Sydney Eye Hospital.

Endothelial keratoplasty (DSAEK or DMEK)

Endothelial keratoplasty, is a newer surgical technique in corneal transplantation, which allows selective replacement of the bottom layers of the cornea through a small keyhole incision. This has become the standard surgical option for patients with Fuchs’ endothelial dystrophy.

Corneal surgeons may be able to replace the inner two layers of the cornea (Descemet’s Stripping Automated Endothelial Keratoplasty or DSAEK).

Moreover, it is now possible to replace only the endothelium with its thin supporting layer in the latest endothelial keratoplasty technique (Descemet’s Membrane Endothelial Keratoplasty or DMEK). This procedure can be done through an even smaller keyhole incision than DSAEK, and hence the recovery time is also quicker.

Key benefits of Endothelial Keratoplasty over older surgical techniques, such as full thickness corneal transplantation, include:

  • Faster post-operative recovery time
  • Better visual outcomes
  • Lower graft rejection rates
Penetrating Keratoplasty (PK)

Traditionally, a Penetrating Keratoplasty (PK) will be performed in which the full thickness of the patient’s cornea will be replaced by a donor corneal graft. Although the success rate of PK is very high, the post-operative recovery time is relatively long and sometimes it may take years to achieve functional vision in the operated eye. Also, there is a higher risk of graft rejection compared with other types of corneal transplantation.

Deep Anterior Lamellar Keratoplasty (DALK)

Deep Anterior Lamellar Keratoplasty (DALK) is the latest surgical treatment of choice for keratoconus. Instead of replacing the full thickness of the cornea, only the top 80% of the cornea is replaced.

The bottom two layers (Descemet’s membrane and endothelium) of the patient’s cornea are preserved as these layers are not affected by the disease process.

This technique may shorten the recovery time and reduce the risk of corneal graft rejection.

Corneal collagen crosslinking

Corneal collagen crosslinking therapy is a proven therapy for the treatment of keratoconus, an eye condition in which the cornea becomes thin and bulges outward to form a conical shape.

In recent years, corneal collagen cross linking has been utilised to halt the progression of the disease by stiffening the abnormally weakened collagen fibres within the cornea. In addition, this procedure may help to improve patients’ vision, although this beneficial effect is not always predictable.

Corneal collagen crosslinking therapy can be safely performed by your corneal specialist as a day surgery procedure with minimal downtime. The primary aim of this procedure is to allow special eye drops that are rich in vitamin B2 (riboflavin) to diffuse into the cornea. After adequate absorption of the eye drops:

  • Patient is positioned with UV light at a short distance from the cornea for 30 minutes
  • A bandage contact lens will then be inserted and the eye will be patched for 24 hours

The full effect of corneal collagen cross linking may take 6 months or longer to settle, and not all patients with keratoconus are suitable to undergo this procedure. Your ophthalmologist will evaluate your condition before discussing the best treatment options for you.

For more information on corneal surgery, please call Eastwood Eye Specialists for an appointment.