Full (Traditional)

Partial (DLEK. DSEK, DSAEK)

Long history of success over the lifetime of the patient.

Much shorter history of success, with the long-term results and longevity unknown.

A simpler procedure to learn and perform. 

A more difficult procedure to learn and perform.

More surgeons are very experienced in doing full transplants – it is easy to find a good surgeon.

Fewer surgeons are very experienced in doing partial transplants.  It may be hard to find an experienced surgeon in your geographic area. 

All layers of the cornea are replaced.  If you have advanced Fuchs with stromal scarring and/or scarring from blisters, this is probably the only procedure that will be successful.

Short-term successes have been seen in earlier Fuchs where there is swelling in the stroma and the epithelium, but no scarring in these tissues.  Short-term success is less likely if there is scarring in the stroma and/or epithelium. 

New tissue is held in place by 12 to 20 stitches. 

New tissue is held in place with an air bubble (some surgeons are also using just a couple of stitches for this).  The air bubble can cause acute closed angle glaucoma.  If the tissue dislocates, there can be additional cell loss in repositioning the tissue.  Dr. Mark Terry states that the “edges” are not healed for 3 months, so dislocation is possible for some time after the surgery, especially with trauma.

Shape of cornea can change drastically because the shape of the donor cornea may be quite different than the shape of your cornea.  This and the stitches used to secure the donor tissue may cause regular or irregular astigmatism that cannot be corrected with glasses.  Strategic stitch removal can improve this, but RGP contact lenses or refractive surgery may be required in approximately 10% of cases. 

Extremely unlikely that cornea shape will change drastically.  This is considered to a “refractive neutral” surgery.  If your cornea was perfectly round with no astigmatism before, it should be close to that after the surgery.  The astigmatism after the surgery should be close to what it was before the surgery and can be corrected with glasses.

Full (Traditional)

Partial (DLEK. DSEK, DSAEK)

Cataract surgery is done at the same time as the transplant only if needed.

Many surgeons remove the natural lens and replace it with an IOL before or during the partial transplant, regardless of whether it is needed.  This is done because there is a chance of damaging the natural lens during the partial transplant surgery and to give the surgeon more room to maneuver between the back of the cornea and the lens during the partial transplant surgery. 

If cataract surgery is done at the same time as the transplant, there is no way to estimate the “power” of the IOL needed based on the new cornea.  It must be calculated using the old cornea.  For this reason, the IOL might not work the best with the new cornea.  If cataract surgery is done after the transplant, the power of the IOL can be matched to the new cornea. 

If cataract surgery is done at the same time as the transplant, there should be no problem in estimating the “power” of the IOL needed because the shape of the cornea should not change. 

The amount of endothelial cell loss after surgery is known from many studies.  Over time, the rate of cell loss is approximately that of the normal cell loss due to aging.

The amount of cell loss after surgery is still being determined.  If the tissue does not dislocate, the amount of cell loss is initially greater than with a traditional transplant, but at the end of two years, the amount of cell loss is approximately equal to that of a traditional transplant.  Cell loss after dislocation is greater.  The rate of cell loss after two years is not known.

Full (Traditional)

Partial (DLEK. DSEK, DSAEK)

Complications are well known and solutions are known and tested.

Complications and solutions are still being discovered. 

Even after the incision is “healed” – many years after the surgery, trauma can cause the incision to split open.  (One study shows that this happens in about 5.8% of transplants, but that most incidents could be prevented if the eye was appropriately protected.)

Very small incision that heals quickly.  Extremely unlikely to “split” at a later date.

Until “healing” process is complete, many people may see many multiple images for a short time.  In some cases, people may see multiple images for a longer period of time.

Until “healing” process is complete, ghosting, double vision, and edge blur may limit visual acuity. 

Rejection is always possible, but is greatly minimized by the appropriate use of steroid drops.  The steroid drops that are needed to prevent rejection can increase intraocular pressure and/or cause cataracts to form.

Full (Traditional) – Visual Outcomes Summary

Partial (DLEK. DSEK, DSAEK) – Visual Outcomes Summary

Individuals can have visual outcomes that are better or worse than those shown in the studies. 

Most surgeons will wait at least 3 months after surgery to prescribe glasses.  If prescribed before this time, there could be frequent major changes in the prescription.  Vision will continue to improve for at least two years after surgery. 

Individuals can have visual outcomes that are better or worse than those shown in the studies. 

Most surgeons will prescribe glasses at the 1-month or 3-month check-up.  Small changes may be made in the prescription at 6 months or 12 months after surgery.  Vision will continue to improve for at least two years after surgery. 

The available data show that the visual outcome of a full (traditional) transplant is better than a DLEK at 6, 12, and 24 months.  The visual outcomes of a DSEK are slightly better than DLEK and a full (traditional transplant) at 3 months and 6 months.  The visual outcomes of a DSAEK are somewhat better than DLEK, DSEK, and a full (traditional transplant) at 3 months and 6 months.  New studies regarding DLEK, DSEK, and DSAEK are being published every month, so these data may change.  It’s important to remember that individuals can have visual outcomes for any kind of transplant that is better or worse than those shown in the studies.  Each situation is different.