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New corneal transplantation technique offers fewer risks by Heather Woolwine Public Relations A new technique, Descemets Stripping Automated Endothelial Keratoplasty (DSAEK), marks the biggest advancement in years for corneal transplantation.   Performed by David Vroman, M.D., of the Storm Eye Institute, the newapproach to corneal transplants places patient procedures on the frontier of new expertise.   Corneal transplantation has been a successful procedure for more than 50 years with relatively few modifications. DSAEK can be used for patients with corneal endothelial disease, who account for 40 percent of the 38,000 corneal transplants performed in the U.S. last year.   “Historically, for patients suffering from endothelial corneal disease, we would remove their entire cornea and transplant donor tissue in its place,” Vroman said. “While successful, the procedure requires stitches in the eye and poses risk of infection, astigmatism, or eye weakness that could make the eye more susceptible to trauma. With this new procedure, we peel out only the layer of cells that are functioning abnormally and replace those with donor tissue. This way 90 percent of the patient’s cornea remains intact.”   With only a handful of surgeons conducting this procedure throughout the nation and as the first surgeon in the Lowcountry to perform it, Vroman spent the last fours years heavily researching the procedure and now prefers it to more traditional methods. The concept is several years old, but only recently has it been available for routine use in corneal transplants.   There are many reasons a patient requires a corneal transplant. Most commonly, scars, thinning of the cornea or keratoconus, and diseases of the endothelium, or back of the cornea, are to blame. The back layer of the cornea is responsible for preventing water from gathering in the cornea. When the endothelium is diseased, water gathers in the cornea and patients gradually lose sight until they can no longer perform their normal activities.   DSAEK may be offered to any corneal transplant patient with a diseased endothelium. Its advantages are the opposite of the traditional procedure’s risks, including no stitches, no astigmatism, and the eye remains strong. In addition, recovery time is anywhere from three weeks to three months, whereas traditional transplantation could require up to a year of recovery, dependent on the patient.   “The patient’s comfort level is much better, and the procedure is outpatient,” Vroman said. “The surgery itself takes about an hour, in addition to prep time. At the end of the procedure, the patient lies on his or her back while an air bubble inserted into the eye helps to keep the cornea in place. Patients are told to lie on their backs for the rest of that day and are then examined in clinic the following morning. From that point on, all a patient must do is sit back and let the eye heal.”   For most corneal transplant patients, the procedure is required for both eyes, as endothelial disease tends to strike both eyes simultaneously. Each procedure is conducted independently.   For more information about the procedure or to schedule an appointment, call the Storm Eye Institute at 792-8100 or visit http://www.muschealth.com/eyes.     Friday, March 10, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.