Keratoplasty



Keratoplasty or corneal transplant is asurgery to replace the damaged cornea with a new cornea from a donor. To undergo the keratoplasty procedure, JEC currently using IntralaseEnabled Keratoplasty (IEK) and Lamellar Keratoplasty.

Lamellar Keratoplasty technology has been introduced by JEC since 2008, and the Intralase TechnologyEnabled Keratoplasty (IEK) introduced in 2010.


Indication to undergo Keratoplasty procedures, e.g.:
Optics: To fix eyesight so the patients can see clearer.
Therapeutics: To eliminate corneal abnormalities which can damage the eyeball e.g.; Bacterial or fungal infections.
Tectonic: to fix the thin corneal or a hole in the cornea which will threaten the eyeball.


Keratoplasty Surgery Types:

Penetrating Keratoplasty

Thereplacement of the whole host cornea with a donor cornea.

e.g:IEK


LamellarKeratoplasty

Thereplacement of partial layers of the host cornea.

e.g:DALK, DSAEK


What is Intralase Enabled Keratoplasty?

Intralase Enabled Keratoplasty (IEK) is the latest technology of corneal transplant surgery technique utilise Intralase Femtosecond Laser. Thesurgery technique on IEK is difference with conventional keratoplastysurgery. The IEK is a combination between refractive and cornealsurgery.


The advantages of Intralase Enabled Keratoplasty (IEK)

A higher fitting accuracy than the conventional technique.

More corneal donor strength and stability.

Fewernumber of stitches on cornea than the conventional technique.

• The fewer number of stitches also resulting in less risk of post surgery inflammation
• Less astigmatism which resulting in a faster improvement for a better eye vision.
• A relatively faster healing.

Abnormalities that can be treated by Intralase Enabled Keratoplasty (IEK)



 Congenital abnormality / genetic: corneal dystrophy (Fuchs' dystrophy, stromal dystrophy etc.).
 Post-operative corneal edema (bullous keratopathy).
 Corneal scar.


The candidates for IEK treatment.

• Most of the patients with poor vision due to the not clear of foggy cornea, but the nerve and the retina at the back of the eye is still healthy.
• Injury, infection or inflammation of the cornea due to damage of the endothelium.

Procedure of Intralase Enabled Keratoplasty treatment.

  • Intralase Femtosecond Laser will cut the donor's and recipient's cornea with a pre-programmed precision.
  • The type of the recipient cornea will be adjusted to the condition of the patient's cornea.
  • The stability and strength of the donor cornea is usually higher and only a few stitches needed compared to the conventional way.

A day after the surgery, the patient needs to consult the ophthalmologist to make sure the transplantation goes well. 

Transplantation surgery with IEK usually has a good result. There are still at risk of rejection from the recipients. If there a rejection, then the patient needs to undergo another corneal transplant. 

Unlike another organ transplant, a corneal transplant can be done several times. However the success rate will be lower than the first one.



LAMELLAR KERATOPLASTY

On Lamellar Keratoplasty, we are only replacing the damaged part of the cornea while we will keep the healthy part. So the patient's eye adaptation process of the new cornea will be easier and will minimise the risk of rejection” as told by Dr. Setiyo Budi Riyanto, SpM,Chairman INASCRS.


The post-surgery healing process also faster than the conventional method, because it only needs a few stitches during the transplant process” add Dr. Setiyo Budi Riyanto, SpM.

The Lamellar Keratoplasty technique consisted of two types: Deep Anterior Lamellar Keratoplasty (DALK) which intended to replace most of the anterior layer of the cornea including the deeper parts of cornea.The second type is Descemets Stripping Automated Endothelial Keratoplasty (DSEK) to replace the deepest thin layer of cornea through a small hole or section without any stitches afterward.