PARIS, July 11 (EDITIONS) –
The high demand for corneal transplants has led to much research into “artificial corneas” made from new materials or the patient’s own tissue; This would make it possible to produce highly biocompatible corneas without having to resort to donors.
“Corneal transplants are a common procedure in our country given the high success rate and volume of donations. In Spain alone, around 5,000 corneal transplants are performed every year.dr Carlos Lisa, surgeon at the cornea and lens unit of the Fernández Vega Institute of Ophthalmology (IOFV), said in an interview with Infosalus: “This is the most common type of transplant in Spain.
a little more precise, This expert reminds that the cornea is the most anterior tissue of the eyeball, “it would be like the crystal of the clock”, and a window through which we see, “the first lens upon which light strikes as it reaches our eye.” The eye bank is responsible for collecting, examining and caring for donated corneas (from a deceased person) to ensure the suitability of the tissue.
Corneal damage affecting vision
According to the doctor, transplantation is indicated when there are corneal lesions that affect the quality or quantity of vision, and cannot be restored by more conservative techniques. “It is generally due to pathologies that affect its transparency,” he specifies.
Among them, this ophthalmologist points out that infections caused by the use of contact lenses or by the herpes virus, which cause the appearance of opaque scars, stand out.
“Other common pathologies are keratoconus (excessive curvature of the cornea) and Fuchs’ dystrophy, which involves accelerated damage to the endothelial cells responsible for maintaining transparency. These cells are lost naturally over the years, but they can also be damaged after repeated intraocular procedures,” he adds.
Types of corneal transplant
according to dr lisa, There are two types of grafts: the ‘penetrating or whole graft’, the ‘penetrating or whole graft’ and the ‘penetrating graft’.which aims to replace the entire cornea with a healthy cornea, including the three main layers of the cornea (epithelium, stroma and endothelium), and is indicated when the disease affects all; the other option includes anterior or posterior lamellar grafts.
“In the latter case, we only replace the damaged diapers. For example, anterior lamellar grafts are indicated for corneal herpes or keratoconus, posterior lamellar (or endothelial) grafts for Fuchs’ endothelial dystrophy or bullous keratopathy. Lamella grafts are more effective and safer, Facts that translate into faster visual rehabilitation and a lower incidence of complications such as glaucoma, infection or graft rejection, ”explains the specialist from the Institute of Ophthalmology Fernández-Vega.
WHAT THIS PROCESS CONSISTS OF
Today, the surgeon at the Fernández Vega Institute of Ophthalmology’s cornea and lens department says that about 9 out of 10 surgeries are partial corneal transplants. ” In this operation, the damaged layers of the cornea are manually removed while the healthy layers are preserved. In anterior corneal surgery, we remove 95% of the thickness of the cornea formed by the epithelium and stroma, preserving the endothelium so that the eyeball does not need to be penetrated. We then sew up the donor cornea with 16 stitches,” he explains.
In the last ones he indicates that we access the inside of the eye to extract the endothelium (inner layer of 20 microns) and that through a small incision of 3 millimeters we implant a donor endothelium that remains attached to the rest of the diapers without seams.
IS VISION FULLY RESTORED?
With all this, this ophthalmologist points out that since the appearance of lamellar or partial grafts, the postoperative period after the transplant is more relaxed and requires a relative rest of about 1-2 months, after which the patient’s return to the labor market can be assessed .
For visual recreationThe expert of the Ophthalmological Institute Fernández-Vega claims that it is progressive, observing an improvement from the first days compared to the previous situation.
Regarding whether complications could arise, this doctor concedes that “there’s always a possibility” and “no matter how sophisticated the surgical techniques are,” but he insists patients know that keratoplasty is a well-established technique with a is very high success rate.
In the case of releases, he finds it best to refer to them as “episodes” since in the vast majority of cases they can be controlled with eye drops and today rejection with partial techniques very rarely means failure. “The rejection rate is between 1 and 9% for laminar techniques and between 25 and 34% for penetrating techniques,” he specifies. In the latter case, however, he points out that depending on the pathology, oral immunosuppressants may be necessary.
“To improve the prognosis of these penetrating grafts, we have developed a surgical technique called ‘Keratoplasty Protected by a Pseudocamera with Intercorneal Implant’ that avoids perforating the cornea. In the three years that this procedure has been carried out at the IOFV, very satisfactory results have been obtained. Corneas that otherwise would have had a very poor prognosis were advanced. The new implant, which has been CE marked since June 2020, has been supported by the BBVA Foundation throughout the research process at the Fernández Vega Institute and has been developed in collaboration with the Spanish company AJL Ophtalmic, specifies the specialist.
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