Cornea Transplant

What is a cornea transplant?

The long-term success of cornea transplant depends on the cause of the corneal damage, the surgical technique used, expertise of the surgeon, the possibility of organ rejection and other factors.

What is a cornea transplant?

Cornea transplant is a procedure that replaces your cornea, the clear front layer of your eye. During this procedure, your surgeon removes damaged or diseased corneal tissue. Healthy corneal tissue from the eye of a deceased human donor replaces the damaged cornea. For many people, cornea transplant surgery restores clear vision and improves their quality of life.

What does the cornea do?

The clear dome-shaped cornea protects the eyes from dirt, germs, other particles and damaging ultraviolet light. The cornea, in collaboration with the lens of the eye, focus the light that enters the eye so that the vision can be clear.

The cornea is made up of three main layers of tissue, with two thinner layers of membrane between them.

If you have a damaged cornea, you may experience symptoms such as:

  • Pain in the eyes
  • Blurred vision
  • Cloudy vision

Your corneal specialist ophthalmologist will determine the cause and other possible treatments that may resolve these symptoms.

Conditions that damage your corneas and damage your ability to see clearly may require a corneal transplant. These situations include:

  • Fuchs dystrophy, a condition in which the inner layer (endothelial) cells of the cornea die, causing swelling and thickening of the cornea and blurred vision
  • Keratoconus, a condition that causes the cornea to be cone-shaped instead of a dome
  • Infections, which cause permanent damage to the cornea
  • Traumatic injuries that penetrate or create scars on the cornea
  • Previous eye operations that destroyed the cornea
  • Bullous keratopathy, a blister like swelling of the cornea that causes eye discomfort, pain and blurred vision

Keratitis, an inflammation of the cornea caused by viruses, bacteria, fungi or parasites

Your surgeon will recommend one of three surgical options for cornea transplant.

  1. Penetrating keratoplasty
  2. Partial thickness keratoplasty (DALK- Deep Anterior Lamelar Keratoplasty)
  3. Endothelial keratoplasty

The method chosen by your surgeon depends on the cause of the damage to the cornea, the condition of your cornea and your unique needs. In some cases, a cornea transplant may not improve the visionor your surgeon may recommend avoiding surgery.

Regardless of the type of graft you receive, your new cornea will come from a dead human organ donor. Each cornea donor undergoes a thorough examination to make sure it is safe for transplantation. The cornea consists of three layers of tissue. Each surgical option focuses on a specific layer or layers.

Penetrating keratoplasty

Penetrating keratoplasty is also called a full-thickness cornea transplantation, in this procedure, your surgeon uses a small circular blade to remove the entire central part of the damaged cornea and replaces it with a healthy piece of cornea donor of the same shape.

DALK– Deep Anterior Lamellar Keratoplasty

If the inner layer of your cornea is healthy, but the middle and outer layers are damaged, your surgeon may perform a partial-thickness cornea transplant. During this surgery, your surgeon removes the middle and outer layers of your cornea and replaces them with healthy corneal tissue.

Endothelial Kerotoplasty

This procedure can help if the inner layer of your cornea, the endothelium, is damaged. This thin layer of endothelial tissue is called the Descemetmembrane. Surgeons perform two types of endothelial keratoplasty operations:

  • Descemet stripping automated endothelialkeratoplasty – DSAEK
  • Descemet membrane endothelial keratoplasty – DMEK

Each procedure removes the damaged endothelial tissue and replaces it with healthy donor tissue. Unlike other keratoplasty procedures, fewer or no stitches are needed with endothelial keratoplasty procedures. In contrast, an air bubble is used to keep the donor cornea in place. To increase the chances of success, you will need to place yourself face down for a few days after the operation so that the bubble can hold the cornea.

Your corneal ophthalmologist specialist and anesthesiology team will examine your medical history, answer your questions and confirm the surgical plan. 

The surgery itself is an outpatient procedure (you will not stay in the eye center). The operation usually takes less than 2 hours to be performed.

In the first days after surgery, expect your eye to be red, irritated and sensitive to light. Usually, the pain can be controlled with painkillers that your surgeon may recommend. Your eye will be covered with an eye patch after surgery. The eye patch should be worn when taking a shower and sleeping. Your surgeon will also talk about activities that you should avoid, especially any activities that could lead to a direct hit to your eye. For endothelial transplants, you will need to be placed with the face facing up (on your back) for a few days after the operation.

You will have a follow-up visit with your surgeon, usually within 24 to 48 hours of the operation when he willremove the patch of your eyes and check how well your eye is healing. Eye drops and ointments usually prescribed are both antibiotics (to prevent infection) and corticosteroids (to reduce swelling, inflammation, and to prevent rejection).

Sutures may need to be removed depending on the type of sutures and the surgical technique used. If the stitches need to be removed, they may notbe removed for several months.

Your surgeon will recommend that you wear glasses or other goggles for some time to protect your eyes. During recovery, you should not rub or press your eyes. Rubbing can cause damage and interfere with healing.

One of the most worrying complications of cornea transplant is the rejection of the corneal graft. Rejection means that your body’s immune system recognizes the cornea as foreign and tries to fight off the transplant.

The risk of rejection varies depending on the surgical technique used and the condition of your eye. Conditions such as dry eyes, blood vessels growing in the cornea and eye infections increase the likelihood of rejection. In some eyes, a graft will have a very high risk of rejection, and your surgeon may recommend avoiding surgery. Ask your doctor how the condition of your eye affects the chances of rejection.

Other complications of corneal transplant surgery include:

  • Infection – in the cornea or inside the eye
  • Bleeding
  • Glaucoma (increased pressure inside your eye)
  • Fluid leakage from your cornea
  • Detached retina (the tissue covering the back of the eye is removed from the eye)
  • Visual acuity problems (sharpness of vision) caused by an irregular curve in the shape of the cornea
  • Detachment of the corneal graft (for the endothelial graft held in place by an air bubble)

For most people, cornea transplant is very successful in the long run. Your surgeon can help you decide if cornea transplant is right for you.

Can a cornea transplant be prevented?

The key to avoid a cornea transplant is to prevent damage or injury to your cornea. If a damaged cornea does not heal using other methods, a cornea transplant may be inevitable to maintain your vision.

What is the prognosis (perspective) for people who have a cornea transplant?

The degree of long-term success depends on various factors such as the underlying cause of corneal damage, the surgical technique used, the surgeon’s expertise, the acceptance of the patient’s immune system of the donor transplant (organ rejection) and other factors. Because the rates vary so much, you should ask your cornea specialist ophthalmologist about the success rate in your eye. It is important to keep in mind that vision is usually blurred after surgery and will gradually improve over time. The length of time it takes to return to good vision depends on several factors, including the type of surgery performed. It may take up to 12 months for full vision to be achieved in patients who undergo full thickness cornea transplant.

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