Loma Linda University Health Care ophthalmologist offers new procedure for corneal transplantation
By Julio Narváez, MD, and Preston Smith
PHOTO CAPTION: Jeannine Hart, 76, enjoys reading again. “I am so blessed to be able to read the paper, a magazine, without a strong magnifying glass,” she says.
Jeannine Hart believes that good things come to those who wait. She knew the cornea dystrophy would deteriorate her vision. After an unsuccessful cataract surgery, she was referred to Julio Narváez, MD, an opthalmologist at Loma Linda University Health Care, in the spring of 2004. Her best option for restoring sight would be a corneal transplant.
At the time, penetrating keratoplasty (PKP), a procedure that replaces the full thickness of the cornea, was the standard of care. Few improvements had been made to this procedure in the past 50 years.
Dr. Narváez knew a better procedure was just around the corner. Having the possibilities of PKP explained and with the option of a new procedure not too far off, Ms. Hart decided to wait, even though she knew her vision would get worse.
And it did.
“My writing suffered the most,” recalls Ms. Hart. “It’s hard to hold a piece of paper and a magnifying glass and write too.”
During an appointment with Dr. Narváez on January 24, 2006, he was revealed the new procedure. Called Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK), this procedure replaces only the diseased posterior layer of the cornea, bypassing many of the disadvantages of traditional PKP.
DSAEK has been perfected over the last decade. The procedure starts by peeling off Descement’s membrane through a 4.5 mm limbal incision, leaving a smooth corneal host interface. The posterior donor tissue is then prepared with the microkeratome that, with a deep cut, removes the majority of the stroma. The donor disc is folded and inserted in the anterior chamber and pressed into place with an air bubble. It remains fixed in place by the suction action of the endothelium.
The refractive outcomes are far more predictable. Potentially, there is less risk of rejection. Since the procedure is performed through a small limbal incision, like that used for cataract surgery, no extensive corneal suturing is required. There is no risk of exposed or infected corneal sutures. Compared to PKP, there is much greater wound strength which is very important in elderly patients at risk of falling.
After hearing this, Ms. Hart’s response was “I can’t wait!” She was scheduled for surgery on April 26, 2006, to transplant the cornea in her right eye.
“I was anxious to have the surgery,” says Ms. Hart. “I counted down the days to April 26. I had the utmost faith in Dr. Narváez.”
Finally the day arrived, and Ms. Hart reported to the operating room at noon and was prepped for surgery. The procedure began at 3:30 and lasted all of an hour and a half. One of her friends drove her home in Riverside, which she reached by 6:30 that evening.
The biggest thing Ms. Hart remembers about the surgery was that she felt no pain.
“Immediately after the surgery when I could read the paper, a magazine, or a book, and distinguish who the people were on teh TV, I felt like I had a whole new life,” smiles Ms. Hart. “I am so grateful to Dr. Narváez for delaying my surgery until this procedure was available. I am seriously and happily looking forward to having the same procedure on my left eye.”