All Cornea Transplant Posts

This is a photo of an eye that underwent corneal transplant surgery 30 years prior to the time this photo was taken. 15 years ago in an attempt to improve the patient's vision with this eye, a corneal surgeon placed 2 "relaxing" incisions in the donor cornea. These incisions act in much the same way as RK incisions act. The result was a worsening of the patient's vision in this eye. In addition, for the last 10 years this patient had unrelenting pain in this eye. One year ago this eye was fit with a scleral lens which not only improved this patient's vision significantly, but also eliminated the pain she was experiencing. Look carefully at this photo and you will notice 2 green cuts on the donor cornea, one cut located at about 1:00 and the other located at 7:00. A special dye was used to highlight these open incisions, still open after all these years.

The photos and images below are of the right and left eye of a 62 year old woman who underwent corneal transplant surgery in both eyes over 30 years ago followed by 2 "Epi- Lasik" surgeries in her right eye and 1 Epi-Lasik surgery in her left eye many years later. Both of her corneas are extremely distorted and she is legally blind in both eyes without corrective lenses. Both of her corneas are so distorted that eyeglasses and conventional contact lenses are not able to provide this patient with functional vision. In addition, this patient is so light sensitive that she has difficulties keeping her eyes open in brightly lite environments.The 3rd and 4th images are 3 dimensional views of both of her corneas which were generated by our computer. Epi-Lasik is a form of LASIK surgery. I do not know why these surgeries were done on this patient's corneas. Both of this patient's eyes were fit with scleral lenses which are allowing her to see clearly and comfortably for the first time in many years. In addition, with her scleral lenses she is no longer light sensitive.

This is a photo of an eye that underwent corneal transplant surgery (due to keratoconus) over 20 years ago. 10 years later LASIK surgery was performed on the transplanted cornea. In this photo, a special dye was used to highlight the defects on the ocular surface. Look carefully and you can see 2 concentric circles one within the other on the cornea. The smaller circle is the transplanted cornea. The irregularities in the periphery of the corneal transplant are due to the suturing that was done during the transplant surgery. The outer concentric ring is the edge of the LASIK flap. The geographic areas seen in this photo are due to the dry "hills and valleys" along the corneal surface. In all my years of practice I have never seen LASIK performed on a corneal transplant and I do not believe that it is the "standard of care". For over 20 years this patient did not have functional vision with this eye. This eye was recently fit with a scleral lens which for the first time in years is allowing this patient to see clearly and comfortably once again.

The 3 photos shown here were taken recently of the same eye. This eye underwent 3 corneal transplant surgeries over the past 3 years. The reason for 3 corneal transplants was rejection of the prior 2 transplanted corneas. The original underlying reason for these surgeries was keratoconus. The point of my showing these photos is to demonstrate the ripple effect of ocular surgeries.Corneal transplant surgery has also been done on many patients who developed post-LASIK corneal ectasia, which has a similar ocular presentation to keratoconus. For over 2 years this eye was subjected to topical steroid drops multiple times daily in order to prevent rejection of the transplanted corneas. As a result of the steroids, this eye developed glaucoma. The intra ocular pressure in this eye could not be lowered to a proper level to prevent damage to the internal ocular structures. As a result 2 glaucoma shunts were surgically implanted into this eye to allow the proper outflow of the intraocular fluid (aqueous). In the first photo you can see the corneal transplant. If you look carefully you can make out the faint shadows of the glaucoma shunts. In the 2nd and 3rd photos note the large bulbous areas on the white portions of this eye. These are due to the glaucoma shunts. This eye is being fit with a specialty scleral lens which will provide clear vision once again. For many years I have told patients to avoid all types of refractive surgeries. I have also told patients who did develop post-LASIK complications to avoid "enhancements" due to the risk of additional irreversible problems. I hope that these photos bring home this point.

If you are considering a corneal transplant, I would like to present the following photos with a brief patient history. The photos below are of the same eye. The first photo shows an inflamed post-LASIK cornea with a condition known as "hydrops". Due to the poor vision caused by this event, this patient underwent corneal transplant surgery. The 2nd photo was taken 6 months after the transplant surgery. This eye was fit with a scleral lens which is allowing this patient to see clearly with comfortable vision for the first time in years. However, for about one year this patient must use topical steroid eye drops along with other medications to prevent rejection of the donated cornea. The possible side effects of using these medications include cataract formation and glaucoma. While this eye needed to undergo this surgery, it should not be entered into lightly if the cornea is not opaque and the ocular surface is relatively clear. Do your homework, ask questions and get multiple opinions before taking this step.

This note is directed to those considering some form of LASIK combined with corneal transplant surgery. The photos below are of eyes that have undergone corneal transplant surgery. These corneas have either been rejected or are on the verge of rejection. These photos are just a small fraction of the corneas that I have on record. You should also know that the number 2 reason for corneal transplant surgery is rejection of the 1st corneal transplant. I have known many excellent corneal surgeons both in America and in other countries. The most competent and conscientious surgeons seek to avoid performing a corneal transplant at all costs. It is a surgery that should not be entered into without considerable thought. Over the years I have written a great deal about the dangers of LASIK and testified about this before an FDA panel in 2008 so I won't go into this here. If you are entering the medical profession just remember the most basic rule in medicine: "DO NO HARM".

One year ago this patient suffered a blunt trauma to his right eye. This resulted in a severely damaged cornea and a hemorrhage within the eye. Shortly thereafter, his right eye underwent a partial corneal transplant known as a DSEK. In addition, a vitrectomy was done which involves the surgical removal of the vitreous gel within the eye (done to clear away the blood). This was followed by cataract surgery several months later. Due to the ocular trauma and the multiple eye surgeries that were done, this eye was left with no iris and therefore no pupil. In addition, the transplanted cornea while healthy and clear was extremely distorted. Several weeks ago, in an effort to restore vision to this severely damaged eye, we fit this eye with a GVR Scleral lens. Before placing the scleral lens on this eye, it became necessary to provide this eye with a new pupil. This was done by first placing an opaque black soft lens with an 8 mm pupil on the damaged eye. Over this blackened soft lens we placed our specially designed scleral lens. Without this soft/scleral lens combination, this patient's best corrected visual acuity is less than 20/200 with significant distortions. With this specialty lens combination this patient is able to see 20/60 without any distortions. The purpose of fitting this eye with a scleral lens was to correct the distorted vision created by the distorted transplanted cornea. The photo below is of me along with this very special patient. Below left is a photo of his right eye without any corrective lens. Note that there is no iris and no pupil. The lower right photo is of the blackened soft lens with the clear pupil. Over this lens can be seen the gas permeable scleral lens. This patient is able to wear the lens combination comfortably with all day wear.

The 3 images below are of the same eye. 20 years ago this eye underwent corneal transplant surgery. For many years this patient was unable to obtain functional vision with this eye due to a high degree of corneal distortion. 3 years ago, in an effort to make the corneal more spherical, her corneal surgeon decided to perform a modified RK surgery on the transplanted cornea. The result of this RK procedure was continuous pain along with a decrease in the patient's visual acuity. In the first image below, you can see the open RK incisions. A special green dye and filter were used to make this easier to see. In the 2nd photo, which is a profile view, you can see the open RK incision in the lower portion of the transplanted cornea. The 3rd image is a cross section of this cornea taken with a technology known as "Optical Coherence Tomography". The top 2 curved lines represent the front and back surfaces of the scleral lens. The thick curved grey structure below the scleral lens is the transplanted cornea. Look carefully to the left side of this image and you can see the open RK incision that extends half way through the cornea. With this scleral lens the patient is able to see clearly and comfortably for the first time in 20 years.

This patient had corneal transplant surgery in both eyes a number of years ago. For many years he was unable to see clearly with either eye glasses or contact lenses. Two years ago his left eye rejected the transplant and he needed to undergo another corneal transplant operation. Earlier this year we fit this patient with GVR gas permeable scleral lenses which are allowing him to see 20/25 in his right eye and 20/30 in his left eye. He is able to wear both lenses comfortably all day with stable vision. Because his left eye underwent 2 corneal transplant surgeries, he will need to be monitored very carefully with periodic examinations for several years to come.

What you are seeing in this photo is the third corneal transplant that this eye has had to endure. There is an ulcer in the center of this cornea that has not healed despite many weeks of treatment with antibiotics and other medications. You are viewing a corneal transplant that is in the process of being rejected. The purpose of posting this photo is to enlighten those viewing this image that rejection and infection will always be a risk factor in corneal transplant surgery. This type of eye surgery should never be taken lightly. All non-invasive technologies should be considered before corneal transplant surgery is done.

This patient visited our specialty practice from Aruba seeking help for his vision loss. 8 years ago he underwent corneal transplant surgery in both eyes. He was fit with scleral lenses in Europe which were unable to provide him with good vision along with good comfort. 2 years ago we examined him and fit him with GVR Scleral lenses. For the first time since his corneal transplant surgeries he is able to see clearly and comfortably with all day lens wear. The photo below shows a GVR Scleral lens on one of his eyes with a corneal transplant underneath. For the past 2 years his corneal transplants have been stable and clear and the original GVR Scleral lenses look like the day he first received them.

Below is a photo of me, our student extern Jennifer Vicente and our patient Gonzalo, age 93, who visited our practice from Lima, Peru. In 2014, Gonzalo's right eye suffered a retinal detachment. Following the retinal repair surgery, a corneal infection and inflammation took place in this eye which required corneal transplant surgery. Following the corneal transplant surgery, a severe defect in the outer layer of the transplanted cornea occurred which never healed. Gonzalo traveled to Miami to have us fit his right eye with a scleral lens. Upon seeing this defect we decided to use stem cell technology to speed the healing process before attempting to fit this eye with a scleral lens. 4 days ago, a therapeutic device known as the Prokera lens was placed on Gonzalo's right eye and remained on this eye without removal until this afternoon. This device is made from amniotic tissue which is the tissue closest to the baby throughout development in the womb. In addition to helping the baby develop, this tissue has healing properties that aid in ocular surface repair with less pain and scarring and less inflammation. The photos below were taken of Gonzalo's right eye when he first visited us 4 days ago and also today when the Prokera Amniotic Membrane was removed. All of the ocular photos seen here are of the right eye. In the first 2 photos can be seen the large, deep, triangular defect. Fluorescein dye along with a special filter was used as a visual aid to better view the cornea in greater detail. The 2nd set of photos were taken today immediately after the Prokera lens was removed. The large epithelial defect which was present for many months is completely healed. To write that we were surprised would be a gross understatement. 4 days ago, the visual acuity in Gonzalo's right eye was less than 20/800. This afternoon we went through with a scleral lens fitting. With the scleral lens Gonzalo will be able to achieve 20/50 vision. Gonzalo and his family who traveled from Lima to visit us were extremely happy with the rapid healing of his right eye and with his greatly improved vision.

In 2012, this patient's right cornea (the front surface of the eye) was perforated by a sharp blade and had to be sutured in order to avoid corneal transplant surgery. The suturing left this cornea with a scar and a very irregular surface. In addition, internal ocular trauma took place which required cataract surgery and a vitrectomy which involves removal of the interior gel within the eye and replacing it with saline solution. All of the trauma and surgeries left the right eye with a blurred, distorted image which could not be corrected with eyeglasses or contact lenses. Last year we fit this patient's right eye with a GVR Scleral lens which has corrected the vision in this eye from 20/800 to 20/40. He has been able to wear his GVR lens comfortably all day with excellent comfort. When this patient recently returned for a follow-up visit, his vision was stable and his eye was healthy and clear.

This past week we had the opportunity to participate in a documentary filmed at our office about Keer Deng's visual journey from Africa to America. The subject matter of this documentary is gratitude. I am certainly grateful to have played a part in Keer's visual rehabilitation. Information about Keer's special story has been previously posted in January and earlier this month. Our hope is that in the coming months Keer's vision will continue to improve so that he can become visually independent.

This is an update on Keer Deng's eyes and vision. As I posted earlier, Keer is the young man who was blinded in Sudan. Keer underwent a corneal transplant in his right eye. He left eye was destroyed and is incapable of any vision. Up until last week, Keer was only able to tell night from day and make out some shapes. Today, Keer was able to see his teeth when brushing for the first time since childhood. He can also see the food on his plate and identify colors and shapes. A long healing period lies ahead for Keer. I expect his vision to improve in the months to come. Keer's positive outlook on life has been an inspiration for all who have been privileged to meet him including me.