F.A.Q. (frequently asked questions)
(*please note the Important "UPDATE" near the bottom of this page)
In FuchsSupport we believe KNOWLEDGE IS POWER. The purpose of this Q & A page is to provide information for the FuchsSupport members so that they have the information available to make an informed decision regarding cornea transplants and what is best for THEIR future vision. With all of the kinds of choices available now, there are more questions than ever before about what kind to get, when to get them, and what they are. This page, and the links therein, will hopefully explain general transplant information as well as point out the benefits compared to the risks between the kinds available to help you make your decision.
Question: I have fuchs' dystrophy. When is the right time to get a cornea transplant?
Answer: Not everyone who has fuchs' dystrophy will need a cornea transplant in their lifetime. However, if you DO, then it's important that you don't wait until your dr tells you that you have to get one, but that you tell the dr. when it's time. Many drs are waiting for us to tell them we are ready. Others want to wait until we're almost blind before they do anything about it.
If you need to get a transplant, the time to get it is as soon as the fuchs' dystrophy symptoms begin to affect your daily life. In other words, as soon as you find that you have to make any kind of adjustment or change due to the symptoms, then it's time to start thinking seriously about getting a transplant. If you go your whole lifetime and never reach the point where you have to make an adjustment or change because of fuchs' symptoms, then you are one of the lucky ones who never need a transplant! If you need one, what's wrong with waiting? Due to not having blood vessels in the cornea the healing time of a cornea transplant (no matter what kind of cornea transplant you have done) may be 6 months to 1 1/2 years. You need to be able to depend on the other eye to have good enough vision to "carry the load" during the healing time so that you don't lose your independence.
Question: I'm not comfortable with the idea of having someone else's eye. Is a full transplant when you get the whole eye and a partial transplant when you get just a little of it?
Answer: No matter what kind of cornea transplant you get you never get someone's eye. They can't do "eye transplants", only "cornea transplants." Even if you have a traditional full transplant done, you only get a tiny little scrap of tissue (like a tiny piece of skin). Visualize it this way: if you fell and scraped a little skin off your knee, the full transplant is probably smaller than that tiny little bit of skin you just lost from your knee. You don't get "someone else's eye"; what you get is just a tiny little piece of tissue.
Think of a cornea as being like an onion with layers. The total thickness of all of the layers is still like a tiny little scrap of skin the size of your fingernail. If you see that tiny scrap as having extremely thin layers like an onion does, you will be able to visualize the difference between full and partial transplants. With a full transplant it's like taking that onion and cutting a tiny section out from the outside, and replacing a section the same size in there. All the work is done outside. With a partial transplant it's like cutting a small slit in the side of the onion*, reaching in with a tweezers (for example) and pulling out one of the tiny, extra-thin layers in the middle of the onion, taking similar size layer from another onion, folding it over like a taco, slipping it inside the slit in the onion, unfolding it while inside the onion, and then putting an air bubble in the middle of the onion to hold it in place. All of the work is done INSIDE. You can see how very much more complex and difficult it is to do precisely than a full transplant, and how much more skillful experience is involved.
*this is used as an "easy to understand" picture and isn't an actual "step by step" description of the procedure. Some drs are cutting the slit in the cornea as is indicated in this illustration, which is causing more problems than those who are cutting the slit in the sclerea.
Question: Will my eye color change after my transplant?
Answer: What was transplanted was just a tiny little piece of translucent tissue, and isn't the part of the eye that determines eye color. Sometimes after the transplant we hear of cases where someone's eye was dark before the surgery and is lighter colored now, likely due to the fact that the eye was so murky that it distorted the real color from showing through previously. However, you keep your own eye whether you have a full or partial tranplant done, and the eye color wouldn't be affected.
Question: Do I have to get stitches in my eye with a transplant? That sounds horrible! Can I see them or feel them? Do they dissolve?
Answer: If you have a traditional full cornea transplant you will get stitches to hold the cornea firmly in place while it heals. Contrary to what one might think, the stitches used in a full cornea transplant are not felt, nor can the patient see them when using their eyes to view things. There is, right after the surgery, some scratchiness, but it goes away after a few days. They are, for all intent and purpose, invisible and undetectable by the patient. When you have a full cornea transplant you aren't even aware of having any stitches at all. Partial transplants don't use stitches to hold the cornea firmly in place, but an air bubble that's pumped inside the eye instead. The air bubbles create their own problem such as not being secure (therefore causing graft dislocation) as well as increasing the internal eye pressure. There are different kinds of partial transplants. One kind has no stitches (these have more potential damage to the cornea and much more cell loss) and the other uses a couple stitches to close the incision. These are discussed more in a different question/answer. Just as with full transplants, any stitches in a partial transplant are not seen or felt, and the patient has no awareness that they are even in there.
No, the stitches don't dissolve. However, those who have stitches in aren't even aware that they are in there, even after many years. Some drs believe in removing the stitches after the surgery, and others believe in leaving them in as long as they can. When a dr removes a stitch it's done in the drs office. You don't see them removing the stitch, nor do you feel it when they do it.
Question: Will I be blind after the transplant until it heals up?
Answer: No! No matter if you have a full or a partial transplant, you will NOT be blind, but will be seeing out of that eye the next day when they take the patch off! Some people, after a full transplant, are fortunate enough to be seeing 20/25 or 20/30 the very next day, others may only see 20/400 and be "legally blind" for awhile, but even at the worst you will still be able to see and identify people and objects. There will be a long healing time involved, no matter if it's a full OR a partial transplant. However, during that time you won't lose your ability to see and identify people and objects.
Question: My dr recommended a partial transplant for me (DLEK, DMEK, DSEK, or DSAEK). Why would I need to check into it? I trust my dr. to do what's right for me.
Answer: Partial transplants are quite new, and the long-term results are not yet known. The short-term results are generally doing quite well, but they are having problems with graft dislocations, and sometimes pupil problems, iris damage, or scleral bleeds that were not anticipated. Because the long-term results are not known, it's important that you make this decision for youself. Your dr isn't "seeing through your eyes", nor will they have to live with whatever long-term results end up being... you will. This should be your decision and yours alone.
Over 100 years ago, when full transplants were first started, the patient had 2 choices: either go blind or test out this new procedure. Now we have 3 choices: go blind, test out a new procedure, or have a tried and tested procedure done. Please don't let your dr decide this for you. It's every patient's right to be able to decide for themself what kind of procedure they want done. If the dr balks at it, just remind them that you are paying them and not the other way around. The one who is doing the paying (as well a the one who has to live with the result for the rest of their life) should be the ONLY one making the decision.
Question: What is a partial transplant and how does it compare to a full one?
Answer: In a full transplant (called "PK" or "traditional transplant") the dr removes all of the cornea except a tiny outside edge, and sews a complete new donor cornea onto that outside edge. Keep in mind that the cornea is just a tiny, thin bit of TISSUE and not a complete eye. In a partial transplant the dr only removes one or two layers of the cornea, and replaces only those layers. In a partial transplant, instead of stitches, the cornea is held in via an air bubble that's pumped into the eye. There are various kinds of partial transplants. Please click here for explanation of the various kinds of partial transplants.
Question:Is there a difference in post-surgery restrictions between the full and partial transplants?
Answer: Yes. With full transplants the patient can do pretty much everything they want to immediately following the surgery, with lifting and bending restrictions only. With partial transplants most of the drs require the patients to lie flat on their back, as immobile as possible, for anywhere from 4 hours to 48 hours after the surgery.
Question: You say that partial transplants are new. How new are they, compared to full ones?
Answer: Full cornea transplants were the first kind of any kind of transplant ever done. They have been done, with an almost 100% success rate, for over 100 years on literally millions of patients. All of the potential problems have been discovered many decades ago, with solutions found for them, and the long-term results are well-known and successful. Because they remove the entire cornea, the odds of the fuchs' dystrophy returning are slim to none. Over the 100+ years of being done the full cornea transplant has been constantly improved upon, with improvements STILL being made on them. Because of the many decades of improvements on improvements, plus their reliability and stability, these have been known as the "gold standard" of transplants.
The first kind of partial transplant done in the U.S. was the DLEK, with the first couple patients done very late in 2000. The DSEK next, a several years later, followed by the DSAEK about a year after that. Because the DLEK was first by a few years, when we talk about the history of the partial transplants, we need to be looking at the DLEK. Keep in mind that even though the history of the partial transplants dates back to the DLEK, the DLEK is so different from what is done with the DSEK, that you cannot use research data from the DLEK to see how a DSEK will perform. The history may date back to the DLEK, but since most drs are no longer doing the DLEK, the data will have to go back to the DSEK (of which the first couple were done in 2003). It was only in late 2005 and early 2006 that there were large numbers of these done by more than just a few doctors. Prior to that (2003-2005) there only a few drs doing these on a limited number of patients. The DMEK, the newest of all, just started in 2008, and is so different from the DSAEK/DSEK that data for those are also not equivalent to that for DSAEK. Therefore, if you talk DMEK, any data will be on very few patients, the shortest time of all, and cannot be equated with the DSAEK. In fact, there is no data on DMEK at all yet. All of the partial transplants are still considered "investigational".
Question: You call partial transplants (DLEK, DSEK, DSAEK, Dxek) "investigational". Just what does "investigational" mean?
Answer: "Investigational" means that they will find out about the "bugs", complications, and future problems on the patients that they are doing today. They are learning the short-term "bugs" or problems in the procedures from today's patients now. Nobody knows what complications might, or might not, arise years down the road yet. These will be discovered from the patients that the procedures are done on today. Nobody has had a partial transplant done for 20 years to have any idea yet if the transplants will last that long or not....if they will need to be redone 2 or 3 times in between those 20 years.... or if there will be great vision, cloudy vision, or no vision.... diseased corneas or healthy ones.... years after the surgery. That will all be learned on the ones that are getting these done now.
An "investigational" transplant of any kind is one where they will find out what kind of vision you will have years down the road from YOU, because YOU are the very first ones they are being done on. In contrast, traditional, full transplants are being done on an average of 60,000 a year, and have been done for over 100 years. That means several million have been done successfully. We know from many generations of people who had full transplants done that most WILL last their entire lifetime, no matter how many years that will be; whatever "bugs" or complications there going to be on full transplants have already happened decades ago and solutions found long ago; and we have proof from thousands of patients that the disease doesn't come back after a full traditional transplant. Does that mean partial transplants are riskier than full ones? Only YOU can decide that.
Question: I've heard from some people who had partial transplants done, and they are happy with it. Doesn't that mean anything?
Answer: Yes, it means a lot! It means that right now things are going well for them! You will find people who had partial transplants done who are very happy with the results and you will find people who had full transplants done who were very happy with them. You'll also find (if you ask enough people) some who had partial transplants done who did NOT get good vision, or didn't get it very quickly; and you'll find the same from people who had full transplants done. The big things to always remember, though, is that everybody is different and their results may not be yours; and, today's results are no indication of what future vision will be like. In other words, we know the full transplants will, in most cases, last a lifetime and have good vision that whole time, because millions of people have proven that over 100+ years. We have no such proof yet for partial transplants, so we do not know yet. We know the future complications and long-term results of full transplants, we don't for partial ones. So,we just need to keep in the back of our minds that asking people who had one done within the past few years or less will not be any indication of what vision will be like for them- or you- in the future, we don't know if the disease will come back later for you or them yet, or how many times they will need to be redone during the years, since we don't know any more about them than just the first few years of very limited data so far. They are "learning as they go" from the patients who get them now.
Question: Isn't it true that the drs couldn't do this in the U.S. unless it had been fully tested out thoroughly for a long time?
Answer: Prescriptions and surgical equipment have to go through rigourous testing and get approval before drs can use them. Even after going through these, it often takes a decade or more before the first problems begin appearing. One example of that is the silicone breast implants. These were rigorously tested and then approved by the government as being safe, but it was only after doing them for more than a decade that the dangers began appearing. The first partial transplant (the DLEK) went through a few intial tests on some patients to begin with, but not a rigorous testing program such as prescriptions or surgical equipment go through. Please be aware of these things:
- not everyone has the same experiences. Surgical procedures must be done on thousands of patients before they have a good "feel" for what will "commonly" happen and what might happen occasionally, and what they should expect or watch for.
- nobody will know the long-term effects on vision and the eyes until many years after the first ones have been done. The patients who are getting the new partial transplants NOW are the ones that they will find out about the long-term effects on vision and longetivy of the graft from. Nobody knows today how long the grafts will last, or what the vision will be like between now and the end of the patient's life, not even your dr.
In a "nutshell", the patients who are getting these done today are the ones who are doing the "testing" on these procedures. If you choose to have one of these done, you should do so with the knowledge that you are one they will be doing all of the testing and learning from.
Please also be aware that any comparisons made between full transplants and partial transplants results are not exactly comparing "apples to apples" in that: 1) most drs doing partial transplants are starting with much higher cellcounts in the donor tissue than they do with full transplants. This gives much more room for cell loss in partial transplants than full ones.
2) If the patient doesn't "push" their dr for a transplant, many like to wait until you're almost blind before doing full transplants. In contrast, many are doing partial ones earlier.... thus "skewing" the results in comparison, since the better the pre-transplant vision USUALLY the better and faster the post-transplant vision in either full or partial transplants.
Question: If I decide to have a partial transplant, and nobody near me has done very many, I'd like to travel to find a dr somewhere else who has experience with them. Are there any problems connected with that?
Answer: After a transplant there will be quite a bit of followup work. You will be needing to see someone who knows what they are looking for afterwards. Even though the local dr you see may have experience doing full transplants, there are problems involved with partial transplants that they not only may not be familiar with, but may not know what to look for. If you are having followup work done by a dr who isn't experienced with partial transplants, you run a risk of the dr not spotting things that are not "normal" for a partial transplant, and possibly losing the transplant. Your safest bet for your future vision is to have a dr who is experienced with the procedure doing both the surgery AND the followups afterwards. Keep in mind, also, that if you are depending on the far-away dr who did the surgery to also do the followups, that graft dislocation in partial transplants is one of the most common problems afterwards. In graft dislocation, it is urgent to get diagnosis and treatment as soon as possible. Graft dislocation can drastically increase eye pressure inside the eye, and this massive pressure increase can create problems if not take care of quickly. If you have to travel far to get to the experienced dr who did the surgery, the time delay to get there may leave less that he can do to fix the problem.
In addition, since both full and partial transplants run a risk of rejection or graft failure for the rest of your life, it's important that for the rest of your life you have someone as close as possible to run to whenever something is "different" to check it out. It's better to go to an experienced dr and find out that what is happening is "normal", than to either not go, or have someone inexperienced with the procedure check, and find out later it was important. The sooner problems are detected and fixed the better chance you will have of correcting the problem and saving the cornea. It's generally understood that there is about a 48-hour "window" if a rejection starts. If you can get started turning a rejection around within 48 hours of it starting you have a good chance of saving it.
If you're planning on traveling further away to get a specific kind of transplant done, please think this through very carefully as distance to get help may sometimes mean a huge difference in your future vision, if you have any common (or uncommon) problems afterwards. Most of the time it's better to have the closest experienced surgeon work on you possible.... whether that closest experienced surgeon is only experienced with successful full transplants, or partial ones.... and have them do for you the kind they are the most experienced with doing successfully. Then have the dr who did the surgery also do the followup work.
Question: What kinds of questions should I ask my dr if he's doing partial transplants?
Answer: If your dr does one of the new procedures, and you choose to have it done, it's very important that you ask your dr how MANY of them he's already done, for how long,and what THEIR success rate is. True, even the FIRST dr's "success rates" won't be any indication of the long-term success at this point yet. However, it's important for YOU to know if you're one of the first 100 that he's done or not, considering how much more difficult they are to do than a traditional transplant. All too often a dr who is just beginning to do a new procedure will quote what he's heard of as possible results from the dr who taught him/her, without having much (if any) personal experience doing it himself/herself. Unless you want to be one the dr is "practicing" the new procedure on, it's important to find out his OWN experience with doing them by asking them the following questions:
1) How long have you done traditional full transplants?
2) About how many patients did you do traditional full transplants on?
3) How many of the full transplants that you did have a problem that had to be "fixed" right after the surgery?
4) How long have you done this kind of partial transplant?
5) How many patients have you done this kind of partial transplant on?
6) How many of this kind of partial transplant that you did have a problem that you had to "fix" shortly after the surgery, such as graft dislocation, increased pressure, pupilary block, or air bubble problems?
7) What has been the average cell loss on the patients YOU'VE done partial transplants on (either as a number or a percentage)?
8) Are you hearing that these may need to have to be redone every 5-10 years? How many times will the eye be able to withstand redoing them and still maintain useable vision?
Experience is important. The safest kind of ANY major surgery is the one that the dr has the most experience doing with the least problems post-surgery. Think carefully about the answers the dr gave you regarding their experience. It is every patient's right to choose for themself which kind of transplant they want done: a full one or a partial one. This should NEVER be the dr's call, but ONLY the patient's call, since the final results will be ones that the patient has to live with the rest of their life, and not the surgeon. Every dr who does partial transplants can also do full ones if the patient prefers. For a complete list of general cornea transplant questions to print out and ask your dr (the partial transplant questions in here are ones that Dr Terry, the U.S. inventor of partial transplants strongly suggested asking the dr prior to letting them do a partial transplant on you): click here
Question: I have corneal blisters because of my fuchs' dystrophy. Will that affect what kind of transplant I have done?
Answer: You have to be aware that blisters leave scarring on the epithelium layer of the cornea, and/or the sclera layer. These layers are not replaced with a partial transplant, but they are with a full one. There are some drs who are doing partial transplants on patients who had blisters, but that usually means a second procedure that would need to be done later to laser off as much of the scar tissue as possible. In many cases this procedure wouldn't leave the cornea as clean and good as it would be if it were an epithelium layer that had never had blisters in the first place. Think of having a severe burn that left scar tissue on your arm or leg. If the dr removed the scar tissue with a laser there will still remain some evidence of the burn as long as you live. This will remain in your cornea despite the laser work, affecting your vision. If you have blisters, then you have to decide if you want to have a clean scar-free epithelium with a full transplant, or if you'd rather have a partial one and have the additional procedure to remove as much scar tissue as possible later, with the full understanding that the vision after both procedures are done may not be as good as it would be after a full transplant.
If you have more than one eye problem, such as having fuchs' dystrophy and map-dot, this will also have an effect on the kind of procedure you have done. If you have map-dot dystrophy it creates scar tissue on the epithelium (outside) layer, just as blisters would for fuchs'. Doing a partial transplant such as a DSAEK or DSEK will not remove that outside scarred layer, but a full transplant would. If you have map-dot and fuchs', and have a DSAEK or DSEK done you will have to keep going back every 6 months (approximately) to keep having more laser work done on that outside layer to remove scar tissue. This will result in not having as good a vision as you would have if you had an epithelium layer that had never had scar tissue. Having a full transplant not only removes both diseases completely so that you don't have to worry about either reoccuring, but it gives you a never-been-scarred epithelium layer to see through.
QUESTION: Isn't a "no-stitch" partial transplant better than one with stitches?
ANSWER: There are many kinds of DSAEK's (partial transplants). One kind that seems to be gaining in popularity with drs is the "no stitch" kind that Dr Price in Indiana does. This kind does a 3mm incision through the cornea itself. It's important to note that partial transplants, due to the nature of the surgery itself, lose a massive amount of cells doing the surgery- many, many, many more cells than are lost when doing a full traditional transplant. As we've learned with fuchs' dystrophy, the less cells we have, the worse our vision will be. We lose cells normally as we age. Therefore, the amount of cell loss during surgery is something that is important, especially as we get older and lose even more cells. Dr Mark Terry (the original U.S. creator of partial transplants) promotes a kind of DSAEK that has a 5mm incision through the sclera and uses 1-3 small stitches. This kind (through the sclera with a 5mm incision) not only has much less cell loss during the surgery than the 3mm incision, but it also has much less potential corneal damage during the surgery than the one that cuts through the cornea. It's important to understand that stitches are NOT felt or seen by the person who has them, nor by someone looking at them. When you have stitches, you are not even aware that they are in there.
Question: What kinds of problems are there with full transplants and with partial ones?
Answer: Astigmatism can happen after either kind of transplant, although it's spoken of often as a major problem after full transplants, and is sometimes used by drs as a reason to have a partial done instead of a full transplant (see 3rd question down from here regarding this). There are other problems just now being discovered with partial transplants, some of which can never be fixed (unlike astigmatism), such as permanent irrepairable pupil dilation. Both full and partial transplants have the possibility of developing glaucoma due to use of steroid drops after the surgery. Those same drops also have a risk of creating cataracts after the surgery. They also both have the possibility of rejection or infection. There is some talk of having less of a chance of rejection with a partial than a full transplant, but as of yet there is no stastical proof of that. Since partial transplants are so very new MOST of the complications and problems are yet to be discovered with them. We are only beginning to find the problems with them now, such as fast cell death, graft dislocations, closed-angle glaucoma being created as a result of the surgery, iris damage, permanent pupil dilation, and possibly interface haze. In addition, the drs doing the partial transplants generally don't feel comfortable doing cataract surgery afterwards because of the massive cell loss that happens during both partial transplants AND cataract surgery. This is different than full transplants, because there is not nearly as large a cell loss with a full transplant surgery as a partial transplant. This is an important issue, because the fewer good cells there are, the worse the vision. Major cell loss is one of the major problems with partial transplants. Keep in mind that we all lose some cells normally with aging. This (along with having still "abnormal" layers remaining) is one of the biggest concerns of drs for the long-term. They do not know if the huge amount of cell loss will accelerate the normal cell loss with aging, creating a problem in years to come or not. Another problem that partial transplants have that is unique to those surgeries is sometimes a bleed in the sclera the would get blood between the layers of the cornea. This is something that would never happen with a full traditional transplant.
Those who have a partial transplant done now, as young as the process is, will be the ones that they discover the complications and problems in years to come. Please note that nobody (including your dr) knows for sure what problems (if any) may yet be found in years to come on these.
Question: The drs say that the advantage of doing a partial transplant is that it only removes the layer that's diseased and leaves the healthy layers behind. Isn't it better to just remove the "sick" part, and have a less intrusive surgery done?
Answer: All drs admit that fuchs' dystrophy affects all of the layers of the cornea. Removing only the endothelium and descet's membrane, and leaving other ones behind that were also affected by the disease, is leaving problems behind in your eye. For more on this, please note Dr Terry's link below (creator of the DLEK). In this website of Dr Terry's he states under the heading "Optically Clear Cornea":
"...it may be that EK, by its very nature of leaving behind slightly abnormal recipient tissue, will never achieve the consistency of 20/20 visual results that we desire, or that we can achieve with full thickness PK. " (When Dr terry refers to EK, he's lumping all of the kinds of partial transplants in that one category.)
Interesting that the non-replaced layers of the cornea are not normal.... thus leaving us wondering not only what the vision result will be today and in future years, but also whether or not the disease will return later. Since these are all so very new nobody knows that for sure yet.
He also refers in there, under the same heading, to a "chronically edematous cornea ", which sounds suspiciously like fuchs' dystrophy. This means that either the cornea still has the disease, or it still carries the effects of the disease. It is also true that the partial transplant cornea is much thicker and has more possible edema than a full one. Whether Dr Terry is indicating that this thicker, swollen cornea, will remain that way indefinately, or whether he's referring to the remaining tissue as still being "edematous", he is surely indicating the existence of "slightly abnormal" layers being left behind in partial transplants. Nobody knows what the long-term results of that will be yet.
Question: The drs say that if the partial transplant has problems, they can just redo it as a full transplant. Doesn't that make it perfectly safe to get them, with the "safety net" of still being able to redo them as full ones?
Answer: Keep in mind that this would involve a second major trauma to the eye, in addition to more costs and starting over with healing time. This is not something to be "taken lightly". The fewer traumas to the eye the better. Each trauma and/or surgery you have weakens the eye more. Also, please refer to the question regarding the problems found on partial and full transplants. . Some of these problems from partial transplants can't be "fixed" by redoing them as full transplants, such as permanent pupil dilation (which are not in the cornea, and therefore wouldn't be "fixed" by replacing the cornea). We have to be aware that a problem in one part of the eye (such as the cornea) may very well create a problem in a different part of the eye.... just replacing the cornea in a full transplant wouldn't change the non-cornea sections that may have problems as a result of the partial transplant. If we don't know yet what kinds of problems will show up in the future, how can anyone know yet if they will be fixable or not by redoing it as a full transplant??
Question: Isn't one of the advantages of having a partial transplant that I wouldn't have astigmatism afterwards?
Answer: Astigmatism isn't anything to fear, nor a good reason to select one procedure over another. Many people, even those without any eye disease or transplants, have astigmatism. It isn't uncommon. Also, not everyone who has a full transplant has major astigmatism problems. Most who have astigmatism afterwards can correct the astigmatism with glasses (a British study showed that 3 months after a transplant 87% of them were correctable with glasses click here for more on that study). In fact, that's the major reason people (even without diseased eyes or transplants) wear glasses... astigmatism! The few who can't correct it with glasses can usually correct it using contact lenses. There are even fewer who can't correct it either with glasses or contact lenses, and these then can have laser correction (Lasik) done on the transplant eye to correct the problem. However, this is not a major issue in most cases of people who have a full transplant. Also, there have already been numerous cases of astigmatism after partial transplants, so it's not a "given" that you'd avoid it by going that route.
Question: Isn't one of the advantages of having a partial transplant done instead of a full one that I'll get faster good vision?
Answer: Some people can see well quickly after a partial transplant, and others can't. Many people who have partial transplants get "interface haze" which blurs vision similar to having fuchs' dystrophy vision. Sometimes that "haze" lasts a couple of months and sometimes a year or longer. Other people have other problems show up, such as pupil problems. Both partial and full transplants have some people who can see well quickly, and both have some people who do NOT see well quickly.
Generally speaking how quickly you get good vision afterwards isn't as dependent on the KIND of procedure you have done as it is on the person it's done on, which eye is being done on that person, and how experienced the surgeon is in doing that procedure. This will vary so much from person to person (and even from eye to eye on the same person), with ANY kind of procedure, that it is not something any patient can absolutely depend upon happening in their situation, and therefore is not a solid reason for choosing one way over another.
Question: If I have a transplant in both eyes, will I be "fuchs' free" and the disease not come back?
Answer: This is something that can't be answered with a "yes" or a "no". No matter what kind of transplant you have done you will still have the DNA in your body, so if you have transplants and then have children, your children still have a 50% chance each of inheriting it from you.
Traditional full transplants have been done so long now that they have had statistical proof for many decades now that the disease won't come back in almost every case. The disease progresses from the center of the cornea outward towards the outside edge. If the patient/dr waits until the disease has gone all the way to that very very tiny outside edge that has to remain for a full transplant (to sew the new one onto), there have been isolated cases where the disease has gone back into the new cornea. Since most don't wait that long, though, the risk of that happening is very very slim.
With partial transplants, there is the hope that the disease won't come back like it doesn't with full ones. However, because they are too new yet, there is no stastical proof of that yet. Since we know that there is a possibility of the disease "migrating" from old to new, having several layers of the old cornea remaining with a partial transplant, and there is no scientific proof that the disease is limited to just the endothelium (see a different question in this page), there is a big question mark that is yet to be determined as to whether or not someone with partial transplants in both eyes is truly "fuchs' free" or not, like they are with a full transplant.
Question: What reasons are there for me to get a partial transplant instead of a full one?
Answer: Less stitches, possibly less astigmatism, and sometimes somewhat faster healing time. However, keep in mind that not everyone who has partial transplants expecting fast good vision may not get the good vision as fast as they expect, nor as good as they had hoped for.
Question: What reasons are there for me to get a full transplant instead of a partial one?
Answer: If you want a method that's been "tried and true" for generations then go for the full transplant. If you want one with the least risk, and the best possible vision, even if the healing time might be a little longer, and want the assurance that the disease will almost certainly not return, go with a full transplant.
In conclusion, please take the time to read through our comparison page comparing full and partial transplants prior to making your decision of what kind of transplant to get. click here to see comparison page
UPDATE (dated August 2008): Quite a few doctors are beginning to say that the partial transplants will need to be redone every 5-10 years due to cell loss. This is not definite yet as of this point, but simply what many drs are starting to say they anticipate happening. As we've learned with fuchs', the fewer the cells we have in our endothelium the poorer our vision. Nobody knows as of yet what the rejection rate or graft failure rate will be for the partial transplants (DSAEK, DSEK, DLEK, DMEK), to know the longevity of the graft. The statement of the possible need to keep redoing the transplants is not due to any foresight about graft longevity, but based on what the drs are observing in their post-DSAEK patient's cellcounts over time. However, if these drs' statements are correct, and they will need to be redone every so many years, that brings up a question for you as the patient: How do you feel about having to go through this surgery over and over every so many years? It also brings up another question for the drs that they do not have an answer to yet: Knowing that each redo will weaken the cornea, how many times will you be able to redo these before you reach the point where you can no longer redo it as a partial nor do it as a full transplant?
Note that the full transplants, in most cases, last the whole life of the recipient without needing to redo them. Some drs are saying now that the full ones also need to be redone, which is extremely odd because prior to the existence of partial transplants they told us that most full transplants will last for our whole lifetime. Their first statement about MOST full transplants lasting the lifetime of the recipient has been proven by 100+ years of experience and history. For the few full transplants that would need redoing, the only reasons are graft failure or rejection, which can also happen with partial transplants. Cell loss is not an issue with them.
Copyright © FuchsSupport Owner. All Rights Reserved. No part of this website (including the logo) may, for commerial, profit-making, non-profit organization, or other non-personal purposes, be reproduced in any form, or stored in a database or retrieval system, or transmitted or distributed in any form by any means, electronic, photocopy, or otherwise, without prior written permission of the author.