First corneal transplant performed at JBER Hospital
By Airman 1st Class Crystal A. Jenkins, JBER Public Affairs
Patients with a common eye disease now have alternatives as the 673d Surgical Squadron and Ophthalmology team advanced their skills and performed their first corneal transplant February 27, 2019, at the Joint Base Elmendorf-Richardson Hospital.
The hereditary eye disease known as Fuchs’ Corneal Dystrophy displays symptoms which for most can often become noticeable after the age of 50 and can ultimately cause a significant loss in vision.
This loss of sight can be treated with two different methods of cornea transplant known as Descemet's Stripping Endothelial Keratoplasty (DSEK) and Descemet's Membrane Endothelial Keratosplaty (DMEK).
The JBER patient who received the first corneal transplant, John Anderson, is a retired military member and pilot who had multiple symptoms which include, blurred vision.
“It takes a little bit of time to recover, but this surgery will help keep my vision from deteriorating in the near future,” Anderson said. “I’m grateful there was a doctor here able to perform this kind of surgery. After doing a lot of research myself, I’m glad this was able to be done before it became too severe.”
Long before a decision is made, a patient with Fuchs’ must first understand how the cornea works, since the disease initially only affects a single layer of the cornea.
The cornea, which is the clear window on the front of the eye, is comprised of three main layers—the epithelium, stroma and endothelium. The epithelium is a barrier which protects the cornea from dust, debris and bacteria. The stroma is the middle layer and makes up 90 percent of cornea thickness, mostly of collagen and other structural materials. It gives the cornea its strength and dome-like shape. The endothelium, one layer of cells on the Descemet membrane, provides the appropriate balance of fluid in the cornea, keeping it thin and clear.
“While attending Harvard ophthalmology’s primary teaching hospital, Massachusetts Eye and Ear, I was introduced to both types of treatment and was able to see firsthand their varying success rates,” said U.S. Air Force Lt. Col. J. Richard Townley, 673d Surgical Squadron chief of ophthalmology and refractive surgery consultant to the surgeon general. “It became very important to me to become proficient in performing the DMEK method. By being able to perform this surgery, my patients are now 15 times less likely to experience infection, [they] have a faster rate of recovery, needing only a localized immune suppressant and may not require the continued use of steroids for the rest of their life.”
Recognizing the symptoms and seeking specialized care during the early stages of Fuchs’ helps ensure patients receive appropriate treatment before the corneas have become permanently damaged from more advanced stages of the disease (i.e., scarring from longstanding corneal swelling).
“Corneal scarring is the one factor that imparts a degree of urgency to deciding when to have a corneal transplant,” Townley said. “In general, corneal scarring limits vision, but it can improve after surgery. Undergoing DMEK surgery before your corneas have significantly scarred gives you the best chance of having good vision after the procedure.”
To understand the varying options, one must do a fair amount of research and have an ophthalmologist experienced in current best practices.
In 2013, Townley was the first Department of Defense ophthalmologist to perform DMEK surgery at Wilford Hall Ambulatory Surgical Center at Lackland Air Force Base, Texas. Now, after performing more than 30 DMEK procedures and seeing the success rate, he has continued taking this knowledge forward in his career and helping more surgical teams become familiar with the procedure.
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