New procedure: The cornea of a patient with peripheral ulcerative keratitis after lamellar keratoplasty. University of Iowa

When there'€™s a problem in your cornea '€” the clear outermost layer covering the surface of the eye '€” vision can be greatly disrupted.

The first sign of a corrupt cornea is when the organ turns cloudy or opaque '€” something that can happen when corneal cells swell or die due to degenerative diseases or fungal or bacterial inflammation.

Improving your vision due to damage to the cornea, whose main function is to refract light, can now be achieved through lamellar keratoplasty, a transplant technique that is relatively new in Indonesia.

Previously, ophthalmologists performed '€œpenetrating keratoplasty'€ procedures, where the entire cornea was removed and replaced with a donor'€™s.

The number of stitches required by the procedure required long recoveries and also could have lead to astigmatism.

Setiyo Budi Riyanto, the chairman of the Indonesian Society of Cataract and Refractive Surgery (INASCRS), said that lamellar keratoplasty allowed ophthalmologists to only replace diseased corneal layers while leaving healthy cells in place.

There are two types of lamellar keratoplasty: deep anterior lamellar keratoplatsy (DALK), which replaces the anterior and inner cornea; and descemets stripping automated endothelial keratoplasty (DSEK), where the inner cornea is replaced without sutures.

Anthony J. Aldave, an ophthalmologist from the Ronald Reagan UCLA Medical Center in the US, said that the techniques were done through minimally invasive surgeries that resulted in quicker recovery times and fewer post-surgical complications.

'€œAbout two or three months after surgery, the patients can see very well; whereas with the full thickness transplant, it may take a year or more to reach the vision,'€ Aldave said during a recent workshop at the Jakarta Eye Center (JEC) in Cikini, West Jakarta.

Under repair: Images of the cornea of one patient one week (A) and 12 months (B) after posterior lamellar keratoplasty and of another patient three months (C) and six months (D) after the same procedure. Courtesy of NIH

Aldave said that lamellar keratoplatsy offered a reduced chance of injury to the cornea from trauma as opposed to full transplants, among other benefits. '€œOne of the big advantages for the patients is that in the DSEK transplant, the risk of rejection is lower so that patient can enjoy the fact that the visual recovery is much faster.

There was no age limits for patients undergoing lamellar procedures, Aldave said. His youngest patient for the surgery was under 10 and his oldest 98

The technique, which began to see use in 1998, reaching Indonesia in 2008.

Tjahjono D. Gondhowiardjo, the education and development director at JEC, said that only five ophthalmologists in Indonesia '€” all of whom practiced in Jakarta '€” could perform lamellar procedures.

'€œThe limit to the number of ophthalmologists who can do it is because the clinics or hospitals don'€™t have the equipment to do lamellars yet'€ '€” leading many to go to Singapore for the procedure, Tjahjono said.

According to the Health Ministry, corneal ulcers are the fifth most-common cause of blindness, afflicting 8.4 percent of Indonesia'€™s 1.5 million blind.

Limited availability of cornea tissue donors is also a problem, leading ophthalmologists to rely on foreign donors, Tjahjono said. '€œThere are only around 25,000 people who have registered to be donors ['€¦] and that number is very small compared to our total population.'€