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PARIS, July 11 (EDITIONS) –
The great demand for corneal transplants has led to much research in the field of “artificial corneas”, made from new materials or from the patient’s own tissue; thus it would be possible to manufacture highly biocompatible corneas without resorting to donors.
“Cornea transplants are a common procedure, given the high success rate and volume of donations in our country. In Spain alone, around 5,000 cornea transplants are performed each year.Dr. Carlos Lisa, a surgeon at the Cornea and Lens Unit of the Fernández-Vega Ophthalmology Institute (IOFV), said in an interview with Infosalus: “This is the most common type of transplant in Spain.
more precisely, This expert recalls that the cornea is the most anterior tissue of the eyeball “it would be like the glass of the clock”, and a window through which we see, “the first lens that light encounters when it reaches our eye.” The eye bank is responsible for collecting, studying and maintaining donated corneas (from a deceased person) to ensure the suitability of the tissue.
CORNEAL DAMAGE THAT COMPROMISES VISION
According to the doctor, the transplant is indicated when there are lesions in the cornea that affect the quality or quantity of vision, and cannot be recovered by more conservative techniques. “Generally it is due to pathologies that affect its transparency,” he specifies.
Among them, this ophthalmologist indicates that infections secondary to the use of contact lenses or those related to the herpes virus stand out, which cause the appearance of opaque scars.
“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 naturally lost over the years, but can also be damaged after repeated intraocular procedures,” he adds.
TYPES OF CORNEA TRANSPLANTATION
According to Dr. Lisa, There are two types of grafts: the “penetrating or complete graft”, the “penetrating or complete 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 of them; the other option encompasses anterior or posterior lamellar grafts.
“In the latter case, we only replace the diapers that are damaged. Anterior lamellar grafts are indicated, for example, in corneal herpes or keratoconus, and posterior lamellar grafts (or endothelial grafts) in Fuchs endothelial dystrophy or bullous keratopathy. Lamellar 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 at the Fernández-Vega Institute of Ophthalmology.
WHAT DOES THIS OPERATION CONSIST OF?
Today, the surgeon from the Cornea and Lens Unit of the Fernández-Vega Institute of Ophthalmology assures that about 9 out of 10 operations are partial cornea transplants. ” This surgery involves the manual removal of damaged layers of the cornea while preserving healthy layers. In anterior cornea surgery we remove 95% of the thickness of the cornea formed by the epithelium and the stroma and preserve the endothelium, so it is not necessary to penetrate the eyeball. We then sutured the donor cornea with 16 stitches,” he explains.
In the latter, it indicates that we access the inside of the eye to extract the endothelium (inner layer of 20 microns) and that we implant, through a small 3-millimeter incision, a donor endothelium that will remain attached to the rest of the eye. diapers without the need for sutures.
IS EYE FULLY RESTORED?
With all this, this ophthalmologist points out that the postoperative period after the transplant is more relaxed since the appearance of the lamellar or partial grafts, and requires a relative rest of about 1-2 months, after which the return of the patient to the market can be assessed. labor. .
About visual recoverythe expert from the Fernández-Vega Ophthalmological Institute maintains that it is progressive, observing an improvement with respect to the previous situation from the first days.
As for whether complications can arise, this doctor acknowledges that “the possibility always exists” and “no matter how sophisticated the surgical techniques are”, but insists that patients know that keratoplasty is a consolidated technique with a success rate very high.
In the case of premieres, consider it better to refer to them as “episodes”, since they can be controlled in the vast majority of cases using eye drops and it is very rare today, in partial techniques, for rejection to be synonymous with 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 designed a surgical technique called ‘keratoplasty protected by a pseudo-chamber with intercorneal implant’, which avoids perforating the cornea. During the three years that this procedure has been carried out at the IOFV, very satisfactory results have been obtained. Corneas have been advanced that would otherwise have had a very poor prognosis. The new implant, which has been CE marked since June 2020, was supported throughout the research process at the Fernández-Vega Institute by the BBVA Foundation and was developed in collaboration with the Spanish company AJL Ophtalmic, specifies the specialist.