Posterior lamellar keratoplasty in Moscow: endothelial corneal transplant
When the cornea loses transparency due to damage to the inner cell layer, vision becomes cloudy, glare, discomfort, and the feeling of constantly seeing through a thick film appear.
At K+31, we conduct diagnostics, select a gentle treatment option, and explain to patients when posterior lamellar keratoplasty is truly necessary and when observation is possible.
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When do we recommend posterior lamellar keratoplasty?
We don't prescribe surgery based solely on complaints. We first conduct an examination, assessing the thickness and transparency of the cornea, the condition of the endothelial cells, intraocular pressure, and any associated eye diseases.
Surgery may be recommended if:
- Persistent corneal edema
- Fuchs' dystrophy
- Bullous keratopathy
- Vision loss due to endothelial insufficiency
- Failure to respond to conservative therapy
Fuchs' dystrophy
Fuchs' dystrophy is a condition in which the number and quality of endothelial cells gradually declines. In the early stages, a person may notice foggy vision in the morning. Later, vision deteriorates further, the cornea becomes less transparent, and regular glasses are no longer effective.
In cases of severe endothelial insufficiency, we consider endothelial keratoplasty as a way to restore the function of the inner corneal layer and improve vision.
Bullous keratopathy
Bullous keratopathy develops when persistent swelling causes painful blisters to form on the corneal surface. The patient may complain of stinging, tearing, decreased vision, and severe visual discomfort.
Corneal edema after surgery and inflammation
Sometimes the endothelium is damaged after complex eye surgeries, inflammatory diseases, or injuries. If the tissue does not recover, a corneal transplant may be necessary to treat the swelling. We evaluate the cause of the problem and choose a treatment plan only after diagnosis.
How we choose tactics: DMEK or DSAEK
The choice depends on the condition of the cornea, the severity of the swelling, previous surgeries and the anatomy of the eye.
When DMEK is appropriate
This technique involves transplanting Descemet's membrane with endothelial cells. This option is suitable when the remaining layers of the cornea are preserved, there are no severe scars, and the main problem is with the endothelium.
The advantage of this method is a thinner graft and the ability to achieve high-quality vision for the right indications.
When choosing DSAEK
This involves transplanting the endothelium along with a thin layer of stroma. This method may be preferable in cases of more complex ocular anatomy, severe edema, repeated interventions, or an increased risk of unstable graft attachment.
We tailor the approach individually and discuss with the patient in advance which option is safer.
| Method | What is replaced | Indications | Recovery | When to choose |
|---|---|---|---|---|
| DMEK | Only the endothelium and Descemet's membrane | Early stages of endothelial failure | Often more rapid | When the remaining layers of the cornea are preserved |
| DSAEK | Endothelium and part of the stroma | Severe edema, complex cases | Stable and Predictable | For complex anatomy or repeated surgeries |
| End-to-end technique | All layers of the cornea | Scars, severe damage to all layers | Longer | When a layer-by-layer approach is not possible |
General information
Preparation for surgery and diagnostics
Before the procedure, we conduct a comprehensive diagnostic. This is necessary not only to confirm the diagnosis but also to assess the prognosis. Sometimes, vision loss is associated not only with the cornea, but also with the retina, optic nerve, or lens.
What examinations are needed before the procedure?
Preparation typically includes:
- Visual acuity test
- Corneal examination under magnification
- Corneal thickness assessment
- Endothelial layer examination
- Intraocular pressure measurement
- Fundus examination
- Assessment of concomitant diseases
This diagnostic procedure helps determine the extent of the damage, whether corneal surgery is necessary, and which method is appropriate for the patient.
What is important to tell your doctor before surgery
During the consultation, it is important to tell your doctor about all previous eye surgeries, inflammations, injuries, chronic diseases, and medications you take regularly.
Data on diabetes, autoimmune diseases, allergic reactions, and previous corneal interventions is especially important.
FAQ
Will the surgery be painful?
How does posterior lamellar keratoplasty differ from penetrating corneal transplantation?
How long does it take for vision to recover?
Is surgery possible?
Endothelial keratoplasty is a modern treatment option for conditions affecting the inner layer of the cornea. This method allows for the replacement of only the damaged tissue while preserving healthy structures of the eye.
Why it's important not to delay treatment
If your vision has become blurred, photophobia has developed, swelling has occurred, or endothelial insufficiency is suspected, it's important to consult with a doctor. The sooner your doctor evaluates your eye condition, the more accurately the treatment plan can be chosen and the risk of irreversible changes can be reduced.
Schedule an appointment with "K+31" if you need posterior lamellar keratoplasty in Moscow or an expert opinion on your corneal condition. We will conduct a diagnosis, explain treatment options, and create a clear recovery plan.
Clinical Guidelines of the Ministry of Health of the Russian Federation — https://cr.minzdrav.gov.ru/
Russian Medical Journal, Ophthalmology Section — https://www.rmj.ru/articles/oftalmologiya/
Ophthalmology Bulletin — https://vestnik-oftalmologii.journals.eco-vector.com/
Medvestnik, Ophthalmology section — https://www.medvestnik.ru/
Eyepress Ophthalmology Portal — https://eyepress.ru/
eLIBRARY — a selection of scientific publications on the topic — https://elibrary.ru/
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What is posterior lamellar keratoplasty?
This is a procedure in which we replace only the damaged posterior layers of the cornea, rather than the entire cornea. Most often, this involves the endothelium, which is responsible for maintaining the tissue's water balance and helping to maintain its transparency.
If the corneal endothelium stops working, fluid is retained in the tissue. This leads to corneal edema, decreased vision, photophobia, and, in more severe cases, corneal clouding.
Which corneal layers do we replace?
During layer-by-layer surgery, the surgeon works on the internal structures of the cornea. Depending on the clinical situation, corneal endothelial replacement or endothelial transplantation along with a thin layer of stroma may be performed. This procedure uses a donor graft, which is selected and prepared according to medical standards.
The main goal of the procedure is to restore corneal transparency and create conditions for improved vision. We explain to the patient in advance the planned surgical procedure, why this particular method has been chosen, and what results can be expected.
How does this method differ from penetrating keratoplasty?
A classic corneal transplant is a full-thickness corneal replacement. This method is used for scars, severe injuries, and damage to all tissue layers. However, if the problem is limited to the posterior layer, a complete corneal replacement is not always necessary.
Endothelial keratoplasty is considered a more gentle option because the anterior and middle layers of the cornea are preserved. This reduces surgical trauma and decreases the risk of severe postoperative astigmatism.