Dr. Marco Lombardo and his staff offer their expertise in the diagnosis and treatment of corneal diseases. Dr. Marco Lombardo is actively engaged for years in the study and development of new methods of stem cell transplantation for the treatment of corneal blindness. Below you can find the latest surgical techniques for the treatment of corneal diseases. For more information or to book a visit, please contact our staff.
The phototherapeutic keratectomy or PTK is a technique that is used to remove corneal scars. It is used to remove superficial corneal opacities that arisen as a result of traumas, infections or corneal dystrophies. After surgery, the patient should apply antibiotic and anti-inflammatory eye drops for a few days and artificial tears drops for a few months.
The intervention of “Corneal transplantation” or “keratoplasty” is performed in all those cases for which the corneal tissue is severely damaged. This may occur because of wide and deep corneal scars (after infection or traumas or due to corneal degeneration) or because of its deformation (keratoconus, trauma). The intervention consists of the replacement of damaged tissue with a donor cornea. The new corneal tissue, restoring the transparency of the cornea, will allow the patient to recover vision.
There are several techniques of corneal transplantation, which differ for the portions of the tissue replaced.
The penetrating keratoplasty is the first technique of corneal transplantation and is still the most widely used technique in the world of keratoplasty. It consists in the replacement of a central portion of a full-thickness corneal flap damaged cornea with a healthy donor and transparent. The donor tissue is then sutured to the host tissue.
The visual recovery is usually slow and requires months. The results achieved with penetrating keratoplasty in terms of visual acuity can be excellent, with a full recovery of visual acuity, however, the postoperative astigmatism can be high. After removal of the suture is possible to perform another operation for the correction of astigmatism. The risk of graft rejection is always present throughout the patient’s life, as well as other complications related to the type of surgery.
Deep Anterior Lamellar Keratoplasty
The deep anterior lamellar keratoplasty consists in the replacement of the anterior portion of the corneal tissue. Surgical indications are keratoconus and anterior corneal scarring. The advantage of deep anterior lamellar keratoplasty with respect to penetrating keratoplasty is that it allows to respect the integrity of the eye, thus avoiding some post-operative complications typical of penetrating keratoplasty. The donor corneal flap is sutured in the same manner of penetrating keratoplasty.
The techniques most commonly used are the DSAEK and DMEK, the first consisting in the replacement of the endothelium with some posterior stroma attached and the latter consisting in the replacement of the endothelium.
The indication to endothelial keratoplasty surgery is the Fuchs’ dystrophy or bullous keratopathy in the initial stages. Both are diseases that affect the endothelium and in late stages lead to corneal degeneration. With these new techniques it is possible to intervene at an early stage of the disease, ensuring a high therapeutic success, in terms of visual quality and stability, and a considerable reduction of the risks associated with the surgical treatment.
The advantages of endothelial keratoplasty compared to penetrating keratoplasty are numerous: the visual recovery is fast; the intervention does not require sutures. The risk of rejection of the transplanted flap is low.
The surface of the cornea is covered by the epithelium which consists of several layers of transparent cells that are constantly renewed by the action of the limbal stem cells. When the corneal stem cells are damaged by chemicals, mechanical trauma, infections, abuse of contact lenses, the cornea become opaque and the patient becomes blind from that eye. In these cases, only the cornea transplantation is not sufficient to restore vision. The risk of failure is 100%. It is therefore necessary, before transplantation, to reconstruct the corneal surface, via a graft of autologous stem cells, taken from the healthy eye of the same patient and grown in the laboratory. At the end of the culture (about 3 weeks) and after appropriate checks, the stem cells are grafted on the damaged corneal surface. The literature showed that the overall survival rate of the grafted flap is about 90% at one year, but drops to 74% at 5 years, and 62% at 10 years. After the confirmation of the success of the graft, the ophthalmologist can evaluate if the patient needs the corneal transplantation.