Corneal Transplantation Surgery
The cornea is comprised of several layers. The outer layers of the cornea are typically affected by conditions such as Keratoconus or by trauma or infection. The innermost layer of the cornea is called the Endothelium. This is specifically affected by a genetic condition called Fuchs’ Dystrophy where acceleration of the natural process of loss of endothelial cells results in swelling of the cornea.
Traditionally, most corneal transplantation surgery has involved replacing a full thickness disc of the cornea for disc of cornea from a donor. This procedure is called Penetrating Keratoplasty or PK.
Today, it is considered preferable to replace only those layers (or lamellae) affected by the specific condition and to leave those layers unaffected in place, thus reducing the amount of tissue transplanted. This approach is called lamellar corneal surgery and leads to quicker recovery of vision, it is also thought that in the long term this will result in fewer transplants being rejected by the recipient and this data is increasingly supported by research and audit in this field.
Rakesh has been performing lamellar corneal surgery for approaching 10 years and has active research interests in corneal transplantation surgery including Ultra-Thin DSAEK in which he has contributed to the development of current surgical techniques including performing corneal transplantation without any sutures under topical anaestheia alone.Book a Consultation
At a glance
Local / Topical
Discussed at consultation
Frequently asked questions
What is Deep Anterior Lamellar Keratoplasty (DALK)?
DALK is a technique in which all of the corneal tissue in front of Descemet’s Membrane is replaced leaving the recipients natural endothelial cell layer intact. DALK is particularly useful when conditions which affect only the front of the cornea such as Keratoconus or conditions which cause scarring are present as by leaving the recipient’s natural endothelial cells in place, the risk of corneal transplant rejection are lowered. DALK was pioneered as a technique by Dr Gerrit Melles, a Dutch Ophthalmologist.
What is Ultra-Thin Descemet Stripping Automated Endothelial Keratoplasty (DSAEK)?
DSAEK is a procedure designed to replace corneal endothelial cells lost through either genetic decline in Fuchs’ Dystrophy or following certain forms of surgery i.e. Pseudophakic Bullous Keratopathy.In DSAEK a thin layer of cornea including the endothelial cell layer is injected into the eye through a small entry port 4.1mm in size using a device called an EndoSaver. The disc of tissue which typically measures a tenth of a millimeter (100 micrometers) in thickness comprises the endothelial cell layer, Descemet’s Membrane and a small amount of corneal substance or stroma. This thin lenticule, normally between 8-9mm in diameter is unfolded in the eye, then further stretched using air to attach it to the underside of the cornea.
Rakesh typically performs UT-DSAEK surgery using a sutureless technique under topical anaesthesia, with the surgical time often less than 15 minutes.
UT-DSAEK offers the advantages of more rapid visual rehabilitation than PK. It typically results in a far smaller change in spectacle prescription and has now become the new ‘Gold Standard’ for corneal transplantation for endothelial failure.
Rakesh has been performing DSAEK since 2008 and is considered to be an expert in this technique. He has published and presented work on DSAEK internationally and teaches this surgery to Ophthalmologists from around the world (see Research).
Is Corneal Transplant safe?
For patients in whom other methods of correction are not suitable, corneal transplant is an excellent option. This operation has been carried out for over 100 years, however in recent years this technique has been greatly improved.
The technique involves removing the misshapen corneal tissue and replacing it with healthy corneal tissue. It is a very successful technique with 90% of patients obtaining a great improvement in vision.
From £ 7,500
What our patients say...
Dear Rakesh, Thank you so much for all your help and guidance. Your knowledge and expertise has been invaluable. Both myself and my family are enormously grateful for this life changing procedure.
Patient, Nuffield Health Guildford Hospital
I am truly delighted with the service I have received with LaserVision. Everything was very well explained. My vision is now fantastic and no more glasses or contact lenses! Thank you all
Patient, Manchester Royal Eye Hospital