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Corneal Transplant & PKP

In New York City

PKP (Penetrating Keratoplasty) grants the ability to treat disease in the epithelial, stromal, and endothelial layers. A full-thickness graft also eliminates optical interface related visual problems that may exist with lamellar transplants with a stroma-stroma interface. The cornea is the transparent front wall of the eye. A variety of conditions can affect the clarity of the cornea. Dr. Rapoport is a specialists in treating diseases of the cornea, offer both medical and surgical treatment options for these diseases.



Why Would I Need Corneal Transplant?

You would need a full thickness corneal transplant if you had a disease or a scar that prevented light from getting in. Examples of diseases that can lead to a scar or a cornea that no longer functions include:
  • Keratoconus
  • Viral infection like herpes or shingles
  • Bacterial infection
  • traumatic scar
  • corneal swelling
Examples of corneal dystrophies/ degenerations that could lead to requiring a full thickness corneal transplant include:
  • Lattice corneal drysrophy
  • Macular corneal dystrophy 
  • Granular corneal dystrophy

What is a Corneal Transplant?

A corneal transplant involves removing the cornea, the clear structure in the front of the eye that is half of a millimeter thick, and replacing it with a cornea from a cadaver. In certain cases, a full thickness corneal transplant is performed (and will be discussed here), and in other cases, a partial thickness corneal transplants, such as a DSEAK, DMEK, or DALK will be performed (and is discussed in another section on this site. Depending on what part of your cornea is diseased/ scarred and how deep it goes will determine what type of transplant you will need.

What to Expect from Corneal Transplants

The corneal transplant surgery is the duration of an hour. There is a little foreign body sensation irritation in the first week of surgery and most people return to their day to day lives in the week following surgery. WIth a full thickness corneal transplant, you take antibiotic drops for about a month and a tapering steroid drop over the first 6 months, with a low dose daily steroid drop the rest of your life. The visual healing process takes over a year, and stitches are removed every few months to improve astigmatism, as guided by topography (imaging). Sometimes glasses or contact lenses are needed to optimize vision. 
With a partial thickness transplant, the visual recovery is a lot quicker, closer to a month. If an air bubble is placed in the anterior chamber to hold the endothelial (partial thickness) graft in place, you will have to lay completely horizontally on your back for 2 days to help the graft stick into place. You will take antibiotic drops for about a month and a tapering steroid drop over the first 6 months, with a low dose daily steroid drop the rest of your life.
Full thickness corneal transplants (PKPs) have a higher risk of rejection than partial thickness corneal transplants for the rest of the graft’s life. Every patient with a corneal transplant needs to be monitored by a cornea specialist for the rest of their lives- initially at 6 month and then at yearly intervals.


What Is PKP?

A penetrating keratoplasty, or PKP, is a full thickness corneal transplant. A full thickness disc of a certain size (usually 8-9mm) centrally is removed from the center of the patients’ cornea using microsurgical instruments. A disc of the appropriate size is then cut from the donor cornea using specific instruments and sutured using microscopic suture in place. The visual rehabilitation of a penetrating keratoplasty lasts about one year. To optimize vision and to decrease astigmatism, individual sutures are removed over the course of the year. Topography (imaging) guides where to remove sutures, and 1-2 sutures are removed every few months, to ensure corneal stability.

What to Expect from PKP?

Postoperative recovery time is relatively long, sometimes taking years to achieve best-corrected visual acuity. Frequently, there is substantial postoperative refractive error due to high regular or irregular astigmatism of the graft, and a higher chance of requiring rigid gas permeable contact lens wear to correct astigmatic error. There is a higher risk of allograft rejection compared with other keratoplasty types. Additionally, PKs carry a higher lifetime risk of wound dehiscence due to the compromised tectonic strength that comes from a full-thickness wound.


PKP with Dr. Rapoport
in NYC

Diligent follow up during the initial year after a full thickness transplant (PKP) is needed to enable optimal healing, and careful monitoring of visual improvement. Dr. Rapoport meticulously removes sutures to improve vision by checking topographies and adjusting sutures at each visit in the year post-operatively. Relying on the most modern imaging modalities that Manhattan Eye has and Dr. Rapoport’s technical skill will ensure that you have a superb post-operative course. 

Corneal Transplant with Dr. Rapoport in NYC

At Manhattan Eye, Dr. Rapoport brings the latest advancements in imaging and surgical techniques to provide the most modern techniques to patients in need of a corneal transplant. She is an expert at DMEK, DWEK, DSAEK and PKP and has published on the post-operative care of these transplants. She brings her delicate surgical touch and warm bedside manner in guiding you through the corneal transplant process.

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