Cornea Program | Vance Thompson Vision
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Cornea Program

DMEK

Descemet membrane endothelial keratoplasty (DMEK) is our treatment of choice for conditions impacting the corneal endothelium and patients who need an endothelial keratoplasty. This partial-thickness transplant is often performed as a treatment for Fuch’s corneal dystrophy and bullous keratopathy, however, very complicated surgical cases may require treatment via DSEK instead. Some major advantages of DMEK over DSEK include decreased risk of tissue rejection and superior visual acuity after healing has occurred. Post-operatively, patients undergoing DMEK can often achieve 20/20 vision, and may even be considered a candidate for an advanced technology IOL, if desired.

 

DSEK

Descemet stripping endothelial keratoplasty (DSEK) is another method of endothelial transplantation. While a DMEK transfers the endothelial layer alone, a DSEK will strip a small layer of the stroma in addition to the endothelial layer. As a result, the transplanted tissue will also include a small layer of stroma. The new interface of host stromal tissue and donor stroma can cause a small hyperopic shift, as well as a slight reduction in visual acuity after the cornea is healed. This procedure is often reserved for patients with complicated anterior chambers such as tube shunts, anterior chamber IOLs, and other complex anterior chamber findings. While some patients can achieve 20/20 vision post-DSEK, the majority experience visual acuity of 20/25 or 20/30 post-operatively.


 

Corneal Cross-Linking

Vance Thompson Vision has been involved with corneal cross-linking since 2011 through our participation in the clinical trials leading up to the procedure’s FDA approval. Corneal cross-linking is a procedure indicated for patients with progressing ectatic conditions like keratoconus and post-LASIK ectasia. We commonly perform epithelium-off corneal cross-linking, as it is currently the approved method by the FDA. During the procedure, the corneal epithelium is loosened and removed, followed by instillation of a riboflavin solution called Photrexa in combination with exposure to a specific spectrum of UV light. The combination of riboflavin and UV light enhances the strength of the stroma by inducing covalent bonds between the corneal collagen fibers. Ongoing FDA studies are researching the stability and efficacy of epithelium-on corneal cross-linking, and the results appear promising thus far. As of October 2025, epithelium-on corneal cross-linking was FDA approved. With this procedure, the corneal epithelium is kept intact and instillation of an oxygen-enhanced riboflavin solution, called Epioxa, is used to penetrate through the corneal layers. Epithelium-on cross-linking may provide reduced pain immediately post-operatively, as well as reduced healing times. After corneal collagen cross-linking, patients can be prescribed scleral contact lenses, update glasses, or explore a surgical option called corneal tissue addition keratoplasty (CTAK) to help correct their vision.

CTAK is a corneal procedure where a small, thin strip of donor corneal tissue is implanted into a channel in the cornea created by a laser. The donor tissue supports the irregular corneal shape, improving the chance that a patient with keratoconus can be more functional with glasses and soft contact lenses. The donor tissue is customized in size, thickness and length to the patient. Before implantation, the tissue is irradiated, making it significantly less likely to fail or reject, and does not require long term steroid use post-operatively. 

 

PTK

Phototherapeutic keratectomy (PTK) is indicated for irregular corneal surfaces, impacted by conditions such as anterior basement membrane dystrophy (ABMD) or anterior stromal scars. Prior to PTK, the only way to remove anterior corneal scarring was via a full-thickness corneal transplant. During PTK, the surface epithelium is first loosened and removed. Then a laser is utilized to remove anterior stromal scars. The laser also improves the ability of the new epithelial cells to grow back in a smoother and more regular fashion. Due to the removal of the epithelium, a bandage contact lens is applied to the ocular surface to promote patient comfort and protect the new cells. The bandage lens is removed around 4-5 days after the procedure, and vision will continue to improve over the following 1-2 weeks. Our very own Dr. Vance Thompson was a national medical monitor in the FDA-controlled clinical trials during the development of PTK in the United States in 1995.

 

SK

Superficial keratectomy (SK) is also indicated for irregular corneal surfaces, usually for ABMD or recurrent corneal erosions (RCE). During the SK procedure, the corneal surface epithelium is loosened and removed. Then, an instrument called a diamond burr is used to polish the surface to create a sticky barrier to allow the new corneal surface cells to grow and adhere smoothly to the basement membrane. Like PTK, a bandage contact lens is placed over the ocular surface to promote comfort for the patient and to protect the new cells. The bandage contact lens is removed around four days after the procedure. Vision will typically fluctuate for up to three months as the eye heals.