Corneal graft

There are various corneal pathologies that require surgical treatment: congenital and acquired corneal dystrophies, stage III-IV keratoconus, keratectasia after previous refractive surgeries, corneal burns, etc. As a rule, conservative (therapeutic) treatment is ineffective for these diseases.
The essence of surgical treatment of these corneal pathologies is to remove and replace the damaged layer of the cornea with biomaterial used to restore the cornea.
Corneal transplantation or keratoplasty is a microsurgical operation in which the “sick” cornea of ​​the patient (recipient) is replaced with a healthy one obtained from a donor.
Corneal opacities, keratoconus, corneal dystrophies of various origins, and previously unsuccessful refractive surgery on the cornea require surgical intervention, namely a corneal graft.
In the case of the most severe diseases of the cornea (after repeated corneal transplants, severe burn sores), if keratoplasty is impossible, the only treatment method is keratoprosthesis - implantation of a special device into the donor graft, followed by suturing it to the patient’s cornea to improve visual functions.
Today, the "Boston Keratoprosthesis" provides a stable and reliable result of keratoprosthesis.

There are three main types of keratoplasty:

1. End-to-end corneal transplant
2. Layer-by-layer corneal transplantation
3. Endothelial grafting

End-to-end corneal transplantation is the traditional, and in many cases, the only possible method. During the operation, all layers of the cornea are replaced, from the epithelium to the endothelium (see anatomy of the cornea in the section keratoconus) with a donor cornea.
Progress of the Keratoplasty operation:

1. From the donor's eye, using a special instrument, a full-thickness corneal disc with a diameter of 7 to 8.5 mm is cut out. At the same time, on the eye of the patient (recipient), using super-precise trephines, a corneal disc with a diameter of 7 mm is cut out from the “sick” cornea.
2. A disk from the donor's cornea is installed in the place from which the recipient's corneal disk was cut out, and is carefully sutured to the remaining part of the “periphery” of the cornea with special sutures 10 microns thick. When performing a layer-by-layer corneal transplant, only the upper layers of the cornea are replaced with the donor one, while the Descemet's membrane-Endothelium complex remains in the recipient's eye without replacement.

To avoid the transmission of infectious diseases, HIV infection, etc. from donor to recipient, and also to reduce the risk of rejection of the new cornea, all donor material used for keratoplasty is carefully subjected to special analysis, preserved in donor cornea banks, from where it goes directly to the operating table at a clearly designated time. The result of the operation largely depends on the quality of the donor material, its processing and storage conditions.

Dmitry Dementyev performs corneal transplant operations (layer-by-layer, penetrating keratoplasty, endothelial transplantation) using material prepared and tested according to standard European standards corneal restoration. The risk of complications and the final result after surgery largely depends on the quality of the material used for keratoplasty (biomaterial awaiting corneal restoration), equipment and conditions in the operating room.