When is a corneal transplant needed?
A cornea transplant may be needed if vision cannot be corrected satisfactorily or painful swelling cannot be relieved by medications or special contact lenses.
What conditions may require corneal transplants?
- Corneal failure after other eye surgery, such as cataract surgery;
- Keratoconus, a steep curving of the cornea;
- Hereditary corneal failure, such as Fuchs’ dystrophy;
- Scarring after infections, especially after herpes;
- Rejection after first corneal transplant;
- Scarring after injury.
Traditional Corneal Transplants
What happens if you decide to have a traditional corneal transplant?
Before surgery
Once you and your ophthalmologist decide you need a corneal transplant, your name is put on the list at the local eye bank. Usually the wait is short. The eye bank tests the human donor for the viruses that cause hepatitis and AIDS before a cornea is released for transplant. The cornea is also carefully checked for its clarity. Your ophthalmologist may also request that you have a physical examination and other special tests. If you usually take medications, ask your ophthalmologist if you should continue them.
The day of surgery
Surgery is often done on an outpatient basis. You may be asked to skip breakfast, depending on the time of your surgery. Once you arrive for surgery, you will be given eye drops and sometimes medications to help you relax.
The operation is painless. Anesthesia is either local or general, depending on your age, medical condition and eye disease. You will not see the surgery while it is happening, and you will not have to worry about keeping your eye open or closed.
The operation
The eyelids are gently opened. Looking through a surgical microscope, the ophthalmologist measures the eye for the size for the corneal transplant.
The diseased or injured cornea is carefully removed from the eye. Any necessary additional work within the eye, such as removal of a cataract, is completed. Then, the clear donor cornea is sewn into place, and a protective shield will be placed over your eye.
After surgery
If you are an outpatient, you may go home after a short stay in the recovery area. You should plan to have someone else drive you home. An examination at the doctor’s office will be scheduled for the following day.
You will need to:
- Use eye drops as prescribed;
- Be careful not to rub or press on your eye;
- Use over-the-counter pain medicine, if necessary;
- Continue normal daily activities, except exercise;
- Ask your doctor when you can begin driving;
- Wear eyeglasses or an eye shield as advised by your doctor.
Your ophthalmologist will decide when to remove the stitches, depending upon the health of the eye and rate of healing. Usually, it will be several months, at least, before stitches are removed.
What complications can occur?
Corneal transplants are rejected about 20% of the time. The rejected cornea clouds and vision deteriorates. Most rejections, if treated promptly, can be stopped with minimal injury. Warning signs of rejection are:
- Persistent discomfort;
- Light sensitivity;
- Redness;
- Change in vision.
Any of these symptoms should be reported to your ophthalmologist immediately.
Other possible complications include:
- Infection;
- Bleeding;
- Swelling or detachment of the retina;
- Glaucoma.
All of these complications can be treated.
A corneal transplant can be repeated, usually with good results, but the overall rejection rates for repeated transplants are higher than for the first time around.
Irregular curvature of the transplanted cornea (astigmatism) may slow the return of vision, but can also be treated. Vision may continue to improve up to a year after surgery.
A successful corneal transplant requires care and attention on the part of both patient and physician. However, no other surgery has so much to offer when the cornea is deeply scarred or swollen. The vast majority of people who undergo corneal transplants are happy with their improved vision.
Stitchless Corneal Transplants
DSEK (Descemet Stripping Endothelial Keratoplasty) is a new option in corneal surgery. Where previously a full thickness corneal transplantation was needed we now have DSEK. It is offered to patients with persistent corneal swelling due to Fuchs dystrophy, failed corneal transplants, swelling induced by prior eye surgery or the aging process of the eye. In those cases DSEK can substitute traditional corneal transplantation and is performed without sutures. The advantages of this procedure include:
Significantly faster visual recovery since no additional astigmatism is induced (2-3 months vs. over a year with standard corneal transplantation).
Chances of corneal rejection are markedly reduced. Only the diseased layer of tissue is removed instead of the whole cornea hence the eye is left stronger — maintaining its normal resistance to injury. It can be combined with cataract surgery.
How DSEK is performed:
DSEK is performed on an outpatient basis. The procedure is done under local anesthesia and takes approximately 30 minutes. The patient is awake but comfortable. The first part of DSEK procedure involves removal of the unhealthy endothelial cell layer. The second part of the procedure consists of replacing the removed tissue with healthy cells from a donor cornea. In order to make the new tissue adhere to the back of the old cornea, an air bubble is used to fill the front part of the eye for an hour after surgery. A follow-up visit is required the day after surgery.
Patients can return to their normal activities within two weeks with the exception of swimming. An antibiotic eye drop is used for two weeks and a steroid drop is used for at least a year to prevent graft rejection. Rejections are rare and treatable.