Corneal Transplantation Surgery

DALK is a technique in which all of the corneal tissue in front of Descemet’s Membrane is replaced leaving the recipients natural endothelial cell layer intact. DALK is particularly useful when conditions which affect only the front of the cornea such as Keratoconus or conditions which cause scarring are present as by leaving the recipient’s natural endothelial cells in place, the risk of corneal transplant rejection are lowered. DALK was pioneered as a technique by Dr Gerrit Melles, a Dutch Ophthalmologist.

DSAEK is a procedure designed to replace corneal endothelial cells lost through either genetic decline in Fuchs’ Dystrophy or following certain forms of surgery i.e. Pseudophakic Bullous Keratopathy.In DSAEK a thin layer of cornea including the endothelial cell layer is injected into the eye through a small entry port 4.1mm in size using a device called an EndoSaver. The disc of tissue which typically measures a tenth of a millimeter (100 micrometers) in thickness comprises the endothelial cell layer, Descemet’s Membrane and a small amount of corneal substance or stroma. This thin lenticule, normally between 8-9mm in diameter is unfolded in the eye, then further stretched using air to attach it to the underside of the cornea.

Rakesh typically performs UT-DSAEK surgery using a sutureless technique under topical anaesthesia, with the surgical time often less than 15 minutes.

UT-DSAEK offers the advantages of more rapid visual rehabilitation than PK. It typically results in a far smaller change in spectacle prescription and has now become the new ‘Gold Standard’ for corneal transplantation for endothelial failure.

Rakesh has been performing DSAEK since 2008 and is considered to be an expert in this technique. He has published and presented work on DSAEK internationally and teaches this surgery to Ophthalmologists from around the world (see Research).

For patients in whom other methods of correction are not suitable, corneal transplant is an excellent option. This operation has been carried out for over 100 years, however in recent years this technique has been greatly improved.

The technique involves removing the misshapen corneal tissue and replacing it with healthy corneal tissue. It is a very successful technique with 90% of patients obtaining a great improvement in vision.