Issue 7.14
Patients with corneal eye diseases now have new treatment options available to them in St. George. Jayson Edwards, MD is a cornea specialist at the Zion Eye Institute. Dr. Edwards is the only fellowship-trained cornea surgeon in all of southern Utah, and he is bringing new cornea treatments to our community that were previously only available Salt Lake City or Las Vegas. In this article he describes one of the new treatments he is providing exclusively at the Zion Eye Institute.
The clear protective layer of the front of the eye, the cornea, is responsible for focusing light entering the eye and producing a sharp image on the retina. Like the lens of a camera focusing light on the film, the cornea focuses light on the retina. The shape and clarity of the cornea is immensely important for precise vision. A cloudy or irregularly shaped cornea can cause vision to be impaired. A poorly functioning cornea may need to be totally or partially replaced by a corneal transplant procedure.
A traditional corneal transplant consists of replacing the full thickness of the cornea with healthy donor tissue and had been actively performed for more than 50 years. Though visual outcomes are generally very good, the large 360 degree wound is weak and there is risk that it may rupture. A new procedure, called DSAEK (pronounced dē’ sek; descemets stipping automated endothelial keratoplasty) is a partial thickness corneal transplant that replaces only the inner layer of the cornea. In patients where only this layer of the cornea is defective, DSAEK offers several advantages over traditional full thickness transplants, including smaller incisions, minimal stitches and faster recovery time.
The innermost layer of the cornea consists of only a single layer of cells called the endothelium. These cells acts like water pumps, pumping out excess water from the cornea to keep it from swelling. Many people, through age, trauma, or genetics have damage to this cell layer, resulting in fluid accumulating in the cornea. The damaged areas are called corneal guttata and can progress to a stage called Fuchs corneal dystrophy. Symptoms include hazy vision in the morning that clears throughout the day, glare, difficulty reading, and poor vision in low light conditions.
DSAEK aims to replace only this inner layer of the cornea. It is performed as an outpatient procedure under topical anesthesia. A small incision is made to gain access to the inner layer of the cornea. This damaged endothelial tissue is removed and a new layer of tissue is inserted into the eye. A few stitches are used to close the wound, and the new tissue is centered and held in place with an air bubble. This bubble holds the new layer against the existing layers of cornea. The patient is then sent home to lie comfortably on their back. The air bubble only remains in the eye for a short period of time and is absorbed over a couple of days.
Most patients notice visual improvement within the first few weeks after the surgery. Full recovery usually takes place over the next three to four months.
Jayson Edwards,MD is the only fellowship trained cornea specialist in southern Utah. Dr. Edwards completed his Corneal Fellowship at Tulane University in Louisiana and is now in private practice with the Dixie Ophthalmic Specialists at Zion Eye Institute in St. George. He specializes in diseases affecting the cornea,including keratoconus,corneal dystrophies,infections and ocular surface reconstruction. He performs corneal transplants,DSAEK surgery,LASIK,cataract surgery and other complicated surgeries involving the front of the eye. For more information call 435-656-2020 or visit www.dixieos.com