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Corneal Procedures

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corneal transplantOur practice specializes in surgery of the cornea, which includes LASIK and other forms of refractive surgery. The cornea is the clear, thin tissue at the front of the eye. It functions much like a "window" through which light passes on its way to the retina. In addition to allowing light to pass, the cornea also "refracts" or focuses light. In fact, it possesses three times more focusing power than the natural lens inside the eye. This is the reason corneal surgery can be such a powerful "refractive" procedure to correct nearsightedness, farsightedness, and astigmatism.

There are major and minor corneal surgeries. Major corneal operations include cornea transplantation and LASIK. Minor operations include pterygium removal and superficial keratectomy. There are many other types of surgery as well. Corneal transplants require a specialist with additional training in this area. Dr. J. Grant Tew completed a fellowship at USC where he specialized in diagnosing and treating corneal diseases. Dr. R. Duncan Johnson successfully fulfilled his fellowship in cornea and refractive surgery at the Jules Stein Eye Institute at UCLA. They are qualified to provide consultations and treat a wide variety of corneal problems, including corneal transplants.

Corneal Transplant

A corneal transplant is performed for various pathologic conditions of the cornea, such as pseudophakic bullous keratopathy (clouding of the cornea after cataract surgery), keratoconus (a progressive ectasia of the cornea), and scarring of the cornea due to trauma or infection, and other problems. It is usually an outpatient procedure and performed with local anesthesia. The diseased portion of the patient's cornea is removed and replaced with the new, healthy donor cornea. Fine nylon sutures are carefully placed to keep the cornea in position and allow for healing. Healing of the corneal edges may take one to two years because of the lack of blood vessels in this tissue. The advantage of this avascular tissue is a dramatically decreased rate of rejection. Cornea transplantation is probably the most successful transplant operation performed, partly because of this low rate of rejection. It is estimated that over 50,000 cornea transplant operations were performed in the USA last year.

Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK)

DSAEK is a corneal surgery procedure for severe cases of corneal disease or for damaged corneas. If you are not familiar with the cornea it is a remarkable structure that helps to focus light and protect the internal structures of the eye. The shape of the cornea is important to the focusing of light on the retina in the back of the eye. A properly shaped cornea and healthy lens will allow this light to focus clearly, providing crisp vision. It is also important that the cornea remain clear so the light can pass through to the retina without being interrupted. If the cornea gets hazy or cloudy, or if the shape of the cornea becomes irregular, vision can be impaired. Some causes of this include age, trauma or disease. When vision is impaired enough to affect a patient’s daily functioning, it may need to be totally or partially replaced by a corneal transplant procedure.

DSAEK is a relatively new, but well tested corneal surgery technique that can help some patients who previously required a full thickness corneal transplant. The procedure is similar to the traditional cornea transplant because both use donor corneas to replaced damaged or disease corneas. Both the conventional corneal transplant technique and DSAEK require use of a donor cornea, but DSAEK replaces only the damaged posterior section of your cornea. This procedure, which requires minimal suturing, allows more rapid visual restoration, less discomfort, and a reduced risk of sight-threatening complications. If you are seeking a DSAEK cornea surgeon in San Diego county or Southwest Riverside County, California we are happy to provide a thorough evaluation.