cell count after cornea transplant

[zenty]

Four years ago I had cornea transplant surgery in one eye and a year later, in the other.  Through testing it is noted that the cell count in one eye is very low.(I think 400. Other eye is 1400.) My surgeon sees advanced type of cornea repair to be needed.  Is time a factor for when this should be done?  We plan to travel, out of the country, during upcoming 5 months. Are there signs for me to watch for that will indicate medical help is needed? Doing what is most important for my visual health is priority. Thanks in advance for your opinion.

[CarolTracy]

I was just diagnosed with Fuch's Cornea Dystrophy, I live in Illinois.  I dont know what my count is but I am wondering how expensive and recovery time is for the transplant?

[Dr1Desai]

Hello Dr. Hagan,
         I am a practising phaco surgeon in India, I would like to have your opinion on one of my complication in cataract surgery.
         Resently i was operating on a patient with bilateral mature hard cataract & a healthy cornea, i started with a side port incision and stained an anterior capsule with trypan blue.
         As soon as i made entry with 2.8 knife, whole of the descmets membrane got stripped off, fortunately i could re-attach the membrane sucessfully, injected an air bubble & abondoned the procedure.
        Next post-op day the cornea was clear & eye was quiet.
        Now my question is : since the patient is having bilateral mature cataract & almost blind...
        1. when earliest i can operate upon this eye?
        2. what precaution should be taken to avoid any further complications?
        Awaiting for your valuable guidance.
        Thanking you,

        Dr. Desai

[John C Hagan III, MD, FACS, FAAO]

You have not been following the discussion threads on DSAEK. I have said many times here that it is revolutionary news surgery that has radically changed the treatment of Fuchs dystrophy and other endothelial dystrophies to safer, faster healing, better visual results, less need for glasses.

My associate Steve Stechschulte MD has performed more of these than any other physician in Kansas City.

JCH MD

[ohsuzzyq2000]

I see your post from 2007 concerning DSAEK as a radical new suregery.
It is no long  radical nor new. It is a better option than a PK ( full thickness transplant) and many many doctors are not doing this surgery
I have Fuchs Corneal Dystrophy and had cell count of 920 corneal thickness  of 650 with my best vision of 20/200

I am 8 monthes postop  now with cell count of 2400 thickness of 500 and best corrected vision of 20/25  I also have mapdot fingerprint dystropy and had to have a stromal puncture and cornea debridement  but all all well thanks to Dr Kristen Hammersmith MD at WILLS EYE HOSPITAL IN PHILA PA


Sue D Phila PA

[John C Hagan III, MD, FACS, FAAO]

Low cell counts don't lead to rejection they lead to graft failure (the cornea can't pump the fluid out), even grafts with high cell counts can get rejected. Rejection is treated and prevented by steroid use.  Any cell count below 300-400 usually causes graft failure.

JCH III MD

[zenty]

Thank you, again,
Other concerns.  Does low cell count lead to rejection? How low can a cell count go?
When I got contacts, the DOC took me off Lotemax.  My surgeon put me back on it.
I notice Dr Price has lead of knowledge on DASEK.
Per your advise I am gaining much information.
You are appreciated.
Zenty

[John C Hagan III, MD, FACS, FAAO]

Of course you should ask your corneal surgeon but as a rule waiting will not increase the risk of surgery.

There are many fine corneal surgeons in St. Louis among the John Purcell MD. Besure an inquire and study DSAEK. Corneal transplants for Fuch's is going to go the way of the horse and buggy.

JCH III MD

[zenty]

Thank you for your information.
Transplants were needed because of advanced Fuchs'.
When I saw my DR in St.Louis, Tues. of last week, the information caught me by surprise since the test used had not been administered on either eye since the corneal surgeries. Along with the low count, there is thickening.
  
Our travel will be in Mexico.
I have read many articles since returning from the appointment. Remaining questions: Is it advised and safe to delay surgery?  Is there a correlation between collagen production and and low cell count? If so is there any way to stimulate collegan production?

I am a 50 year old in a 70 year old body.  Since the transplants I have enjoyed better vision than I had ever known.

Again I thank you. Your professional expertise and efforts to further educate, with needed information, is a gift indeed. Bless you!

[John C Hagan III, MD, FACS, FAAO]

400 cell per square millimeter is indeed low and could decompensate at any time. The symptom of decompensation would be blurred vision worse in the morning than in the evening. Often over the counter Muro 128 drops (2% or 5%) are prescribed during the day usually 4 times and Muro 128 ointment at bedtime. These are hypertonic and us osmotic pressure to try and suck the excess fluid outside the eye cornea.

Waiting on a corneal transplant would not increase the risk of surgery.There is a small chance that blisters could form on the surface, (bullous keratopathy), pop and cause a lot of pain. This is usually treated with a bandage contact lens which any overseas ophthalmologist should be able to place or you could take some with you.

There is a radical new treatment for corneal disease where only the endothelium (inner lining) is sick, in other words where the corneal transplant is not being done for a badly scarred cornea with the prototype being Fuchs' Corneal Dystrophy. Its called DSAEK  Descemet's stripping automated epitheliam keratoplasty.

Not all corneal surgeons do it. It is the wave of the future. It is much safer, much quicker healing, much better vision post operative due in part to no exposed sutures and less astigmatism. You should find out if your corneal surgeon does the procedure. If not you might scout out someone near-by that does the work. If you live anywhere near Kansas City our corneal surgeons have done more than anyone else in town. With some effort you should be able to find someone near you. It is important to be able to return often to see the surgeon.

Do research.

JCH III MD