Corneal transplantation with selective techniques

The cornea is what we could call the window of the eye, since it is the most anterior part of all. When we have an opacity or an irregularity that we cannot repair, we have to use corneal tissue replacement techniques called keratoplasty.

What treatments are currently available for corneal transplantation?

Improvements in some of the surgical techniques have allowed corneal surgery to become much more prominent.

Until 20 years ago, patients who had any corneal problem and needed a transplant had their entire cornea replaced, layer by layer, in a transplant called penetrating keratoplasty.

In recent years, different techniques have been appearing that have also been perfected and that allow selective transplants to be performed. That is, they allow the removal of only those layers that are bad and the transplantation of healthy tissue.

Anterior keratoplasty is performed in pathologies that affect the stroma, that is, most of the thickness of the cornea. Basically, these are scars caused by keratitis, ulcers, trauma, keratoconus, dystrophies or some genetic diseases that produce deposits in the stroma.

On the contrary, there are those patients who have a disease only of the endothelium, either genetic and hereditary or degenerative, which may appear due to a complicated cataract surgery or due to trauma and infections.

When only the inner layer of the endothelium is affected, we perform a transplant called endothelial or posterior lamellar keratoplasty.

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Have the chances of suffering an immunological rejection episode been reduced?

The structure that is most immunologically active is the endothelium, which is the posterior layer. Therefore, 85% of rejections are caused by an incompatibility of that layer and therefore, when we perform anterior transplants in which that layer is not transplanted, there is a very small probability, between 0 and 10 percent throughout the life of that graft that it will be rejected.
If we do a posterior lamellar transplant, it has also been observed that the finer the graft, the lower the incidence of rejection. Therefore, you can go to incidences between 10, 15 and 20 percent over a lifetime of having an immunologic episode of rejection.
Another important thing to point out is how often the word rejection is associated with the fact that the graft has been lost and another transplant may or may not be performed. That is not true, rejection is an inflammatory episode that in most cases if diagnosed, and therefore treatment is started early, can be stopped.