Dr. Olkowski has been a corneal surgery specialist in Hawaii for over 15 years. Before moving to Hawaii in 1990, Dr. Olkowski had an additional year of special corneal fellowship training in corneal surgery at Tuft’s-New England Medical Center in Boston. He has performed hundreds of corneal transplants and currently serves as Associate Medical Director of the Hawaii Lion’s Eye Bank.
Over 100 corneal transplants are performed each year in Hawaii. The cornea is the clear, outer window of the eye and this is the most commonly transplanted tissue. Whole eyes are not transplanted.
Why Do People Need Corneal Transplants?
The most common reason for a corneal transplant is long-term complications from older-style cataract surgery. The cornea becomes cloudy and swollen, and is very painful. The transplant cures these symptoms and gives the recipient great relief. Sometimes corneal transplants are done to correct injured or scarred corneas.
Sometimes a person is born with a misshapen cornea (keratoconus) that needs to be replaced so the patient can see. There are a number of different eye diseases that are cured by a cornea transplant. People of all ages may need cornea transplants. Although many recipients are elderly, our youngest was less than one year old. She was born blind and had her sight restored by the operation.
Endothelial Keratoplasty (EK)
The old adage of, “If it’s not broke, don’t fix it,” has seen new application in the treatment of diseases of the cornea. Dr. Olkowski is a member of a very small group of surgeons worldwide performing a new form of a corneal transplant procedure called EK, which stands for endothelial keratoplasty. This unwieldy mouthful can be explained very simply.
About fifty thousand corneal transplants are performed in the United States yearly, often for patients with corneal swelling or edema. In traditional corneal transplant surgery, the entire central cornea is removed and replaced with a cornea from a donor, much as it has been done for about 50 years. In EK, only the thin damaged back layer or endothelium is replaced, leaving most of the patient’s cornea in place. The expected results include faster return of vision, reduced risks of some complications, and a faster return to daily activities.
This selective type of EK surgery might be better understood with an analogy to car repair. If your car breaks down because of bad spark plugs, it clearly would be better to replace the spark plug than replace your entire engine. EK surgery is more like replacing the bad spark plugs and conventional surgery is more like replacing the entire engine.
Not all patients who require corneal transplants are candidates for EK. This procedure is best suited for those who have corneal edema or swelling. For more information, please call our office and we would be happy to assist you.
IntraLase Enabled Keratoplasty (IEK)
IEK is a revolution in cataract surgery and Dr. Olkowski was the first and only surgeon to perform IEK in Hawaii. EyeSight Hawaii has Hawaii’s only IntraLase laser equipped with the advanced IEK / Cornea module that allows Dr. Olkowski to perform these revolutionary new corneal transplants which make the procedure safer, with faster healing and better visual results for patients suffering from severe corneal disease or damage.
Before the introduction of the IEK technology, corneal transplants were traditionally performed using a handheld, bladed cookie cutter called a trephine that is stamped onto the cornea to make a circular incision with straight, vertical edges. Sutures stay in the eye for one year or longer and patients generally do not achieve full visual recovery for over a year due to increased astigmatism.
Now, Dr. Olkowski uses the IntraLase laser instead of the trephine. Now his cuts are uniquely shaped in patterns such as a zig-zag, top-hat or mushroom. The same exact shape is used on the patient’s cornea and the donor cornea so that they fit together like pieces of a puzzle or tongue-and-groove carpentry. The laser’s infrared light beam is precisely focused within the cornea where microscopic bubbles are formed at a rate of 60,000 per second to establish the incision. The advantage of this technique is speedier recovery and better vision.