A cornea transplant, also called keratoplasty or corneal graft, is a surgical procedure to replace all or a part of your damaged cornea with healthy corneal tissue from a donor.
A cornea transplant is designed to restore vision to a person with a damaged cornea, reduce pain, and improve the appearance of a damaged or diseased cornea.
The cornea is the transparent front layer of the eye that covers the iris (the colored part) and the pupil(the black dot in the center of the iris).
The cornea’s function is to help focus light beams on to the retina (the light-sensitive film at the back of the eye) and then transmit that message to the brain.
If the cornea becomes damaged, the light reaching the retina will be blocked and as a result, the image transmitted to the brain can be unclear and distorted. The cornea also protects the eyes against microbes and dirt, and damaging UV lights.
When damaged, the cornea will become less clear or its shape will alter.
The cornea is made up of three main layers of tissue, with two thinner layers of the membrane between them.
A cornea transplant is most often performed to restore vision to a person who’s cornea is not functioning as it should.
Conditions that damage your corneas and restrict your ability to see clearly include:
If you have a damaged cornea, you may experience symptoms including:
Your ophthalmologist will determine the cause and other possible treatments that may treat and resolve these symptoms. If your cornea cannot be repaired using other procedures, your surgeon may recommend a cornea transplant.
Before your cornea transplant surgery, your doctor will:
During your initial doctor’s appointment, your eye surgeon will explain how the surgery works, what the risks and side effects are, and the results you can expect after your transplant.
Typically the corneas that are used as donors in transplant surgeries, are corneas donated from diseased patients. Many otherwise healthy people decide to have their corneas available as donors for transplants after they are no longer alive, and so there are more corneas available for transplantation.
For other organ transplantations such as livers and kidneys, patients may need to wait in long waiting lists to be able to receive the organ they need, but with corneal transplants, people generally don’t have to wait that long for donor organs.
Corneas may not be used from donors who died from unknown causes and had other conditions such as:
The type of cornea transplant that your doctor recommends will depend on the parts of the cornea that are damaged and need to be replaced.
Usually, surgeons transplant the entire thickness of the cornea (full-thickness), however, with new methods and technical advancements, it is possible in some cases to only have a part of the cornea transplanted (partial-thickness).
These are the main types of cornea transplants:
Before your surgery, your surgical team will sedate you to help you feel relaxed and comfortable, and also give you local numbing anesthetics. This means that you will be awake for the surgery but won’t feel any kind of pain for the process of the surgery.
Other times your surgeon may decide to perform the procedure under general anesthesia.
Full-thickness transplant (penetrating keratoplasty), is considered to be the most common type of cornea transplant.
The operation may be performed with local or general anesthesia, and will usually take around 45 minutes to complete.
During surgery, your doctor will cut through the entire thickness of the diseased or abnormal cornea to remove a small button-sized disk of corneal tissue. This is done with an instrument called a trephine that acts like a cookie cutter and makes the precise circular cut.
The donor cornea, which has been shaped and cut specifically to fit the recipient’s eye measurements, will be placed at the opening of the eye.
Your surgeon will then stitch the new cornea into its place. The stitches will be removed at a follow-up appointment after your surgery when you see your eye doctor.
In some cases, artificial corneas (keratoprosthesis) are used as the new replacement cornea, where patients aren’t qualified to receive donor corneas.
If your surgery is done with a local anesthetic, you will not see through that eye during the transplantation process, due to the anesthetic temporarily disabling the eye.
After a full-thickness transplant, you will be required to stay in the hospital for 1 night.
Some cornea conditions don’t require a full-thickness cornea transplant and other kinds of surgeries are offered instead that remove only specific layers of cornea tissue.
Depending on the exact layer of diseased tissue that needs to be replaced, your surgeon may use various techniques to perform the surgery.
Partial-thickness transplants usually involve either the replacement of either the front portion of the cornea or the back portion.
There are 2 main methods for transplanting the front parts of the cornea, these include:
Just like full-thickness transplantation, during both of these procedures, your surgeon will use stitches to place the donor cornea in its place.
The main techniques for Endothelial keratoplasty (EK) include:
Both of these techniques have lower risks of complications and result in faster visual recovery.
Unlike full-thickness and front portion cornea transplant, your doctor will not use stitches to place the cornea in place. Instead, the cornea tissue will be kept in place by a temporary air bubble.
After the surgery, your team may ask you to lie on your back as much as possible in the first few days after surgery for recovery.
Usually, after a full-thickness cornea transplant (penetrating keratoplasty), you will be asked to spend a night in the hospital.
However, after a partial-thickness cornea transplant, your doctor may allow you to return home the same day after the surgery.
Some common side effects of cornea transplant surgery include swelling and discomfort, but you should not experience severe pain.
After your cornea transplant is performed, you may:
Taking proper and good care of your eye can be vital in keeping your cornea transplant successful, lowering your post-operative complications, and reducing the risks of rejection.
Some important points to remember:
A cornea transplant is a relatively safe procedure, however, like other medical procedures, it carries a slim chance of post-operative complications, such as:
Rejection happens when in some cases, your body’s immune system mistakenly attacks the donor cornea. About 10% of cornea recipients experience rejection after surgery. In these cases, there may be a need for additional cornea transplant surgery and medical treatment.
Signs and symptoms of rejection include:
If you start to develop any of these symptoms, be sure to make an appointment with your eye doctor.
Your visual recovery after surgery heavily depends on the specific procedure your surgeon used and can take as little as a few weeks to up to maybe a year or more, to regain desired visual capabilities.
For some patients, the vision may go from better to worse or vice versa before it becomes settled.
You’ll likely need either glasses or contact lenses, to help with your vision, even after it returns.
In some cases, doctors recommend a minor procedure called arcuate keratotomy (AK) or laser treatment to correct vision problems after your eyes have healed.
Because the rates vary so greatly, you should ask your doctor about the rate of success in your specific situation and condition. Note that in most cases vision is usually blurred after surgery but will be improved as time passes.
The rates of long-term outcomes depend on many factors. These include:
If you have a damaged cornea, you and your ophthalmologist will discuss your options for improving your vision. For people with a deeply scarred or swollen cornea, transplant surgery can restore clear vision. Discuss with your doctor what form of treatment is best for you.
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