After a cataract is removed from the eye during cataract surgery, a new lens, known as an intraocular lens or IOL, is placed in the eye to help the patient see his or her best. Patients with an IOL in their eye are known as “pseudophakic”. There are times when an IOL is not placed in the eye after cataract extraction. Patients without any lens in his or her eye are known as “aphakic”.
Aphakic and pseudophakic patients can sometimes develop a problem with their corneas known as bullous keratopathy. Bullous keratopathy is a swelling and blistering of the surface of the cornea. This leads to decreased vision and an irritated, painful eye. The cause is damage to the endothelial cells of the cornea. These are the cells that line the inner layer of the cornea. They are responsible for keeping the cornea thin and clear, like a piece of glass, so that we can see through it. Without them, the cornea swells, becomes hazy, and develops painful bullae which are blisters on the surface of the cornea.
Treatment early on for aphakic and pseudophakic bullous keratopathy patients, is lubrication with eye drops and hypertonic eye drops. Definitive treatment is surgery. Depending on the type of IOL in the eye, it may or may not have to be exchanged. Additionally, a corneal transplant is required. The endothelial cells, once lost or damaged, are unable to regenerate. A cornea transplant is a way in which we can provide the patient with new endothelial cells. Depending on the situation, either a traditional, full thickness cornea transplant must be done or a partial cornea transplant, known as a DSAEK, can be done. Either way, some form of a cornea transplant is necessary in order to give the patient new endothelial cells.