For patients with injured or damaged corneas, or with degenerative conditions such as keratoconus, corneal transplantation can become necessary. Corneal transplantation is the most commonly performed tissue transplant procedure in the United States. It is a safe, effective procedure, with very low rates of graft rejection compared to other types of transplant surgery.
Until recently, the only form of transplant procedure available was penetrating keratoplasty, or PK, where a circular disc of corneal tissue is removed from the donor cornea, placed into a similarly-sized space in the recipient’s cornea, and secured with sutures. While PK still comprises the vast majority of corneal transplant procedures, there have been several recent advancements in transplant technology.
In the early 2000s, a new procedure, deep anterior lamellar keratoplasty (DALK), was introduced. DALK differs from PK in that the recipient’s innermost layer of corneal tissue, or endothelium, is left intact, with only the central and outer layers being replaced with donor tissue. DALK represents an advance over PK in that the chances of the patient’s body rejecting the corneal graft are much lower.
In the past three years, there has been yet another advance in corneal transplant technology. Dr. Michael J. Bradley, a corneal specialist and surgeon at Hoopes Vision, is one of a select handful of corneal surgeons performing the advanced, laser-assisted FLEDALK corneal transplant procedure. FLEDALK, which stands for Femtosecond Laser Enhanced Deep Anterior Lamellar Keratoplasty, is a version of the DALK procedure. FLEDALK differs from the conventional DALK surgery in that a femtosecond laser, similar to those used to create corneal flaps for LASIK patients, is used to harvest the donor cornea, as well as make the tissue cuts that prepare the patient’s eye to receive the donor tissue. The femtosecond laser offers improved accuracy and precision compared to the manual incisions used in the standard DALK procedure, leading to better tissue alignment, a stronger wound, and faster visual recovery. “These exciting recent advances in corneal transplant surgery should lead to improved patient outcomes,” Dr. Bradley says, “including quicker recovery and lower rates of graft rejection.”