Corneal Transplant Surgery

A corneal transplant is a surgical procedure to replace part of your damaged cornea with healthy corneal tissue from a donor. A corneal transplant is sometimes called a cornea graft or keratoplasty.

The cornea is the clear, front window of the eye. The cornea helps to focus light rays on to the retina. These light signals are then transmitted to the brain to be processed as the images we see. When the cornea is damaged it causes the light signals transmitted to the retina to be distorted or unclear.

If your cornea cannot be healed or repaired, your ophthalmologist may recommend a corneal transplant.

Why is it done?

A corneal transplant is often recommended by your ophthalmologist to restore vision in a damaged cornea, to reduce pain, or to improve the appearance of a damaged or diseased cornea.

The type of conditions that can be treated with a corneal transplant are:

Keratoconus (a cornea that thins and bulges outwards)

Fuch’s endothelial dystrophy (where cells in the inner layer of the cornea begin to deteriorate)

Thinning of the cornea

Corneal scarring, caused by an infection or injury

Clouding of the cornea

Swelling of the cornea

Cornea ulcers, including those caused by infection

Previous corneal surgery or other eye surgery that damaged the cornea.

What to expect during Corneal Transplant Surgery

Your ophthalmologist will discuss the procedure with you and your after care including any potential complications to be aware of.

Arrange for someone to drive you home the next day after surgery. In most cases people will stay one night in hospital.

Most corneal transplants are done with a general anaesthetic. The whole surgical procedure will take approximately an hour.

The type of corneal transplant you will be offered will depend upon the parts of your cornea that need replaced.

During the most common type of corneal transplant (penetrating keratoplasty, PK) your surgeon cuts through the full thickness of the damaged cornea using an instrument called a trephine, to remove a small circular piece of the tissue. The donor cornea is then matched to fit and placed in the opening with stitches. You may be able to see the stitches faintly after the operation.

Some people only require a partial-thickness transplant. The surgeon removes a thin layer of the diseased tissue from the back of the cornea layers (endothelial keratoplasty, DSAEK). A thin disc of healthy donor tissue is placed on the back of the cornea and an air bubble is then put in the eye to hold this new cell layer into place to enable the cornea to heal.

Sometimes the surgeon removes only the front of the cornea (anterior lamellar keratoplasty, DALK), replacing them with donor tissue and stitching them in place.

Partial-thickness transplants generally have a faster recovery time and potentially fewer complications.

Your ophthalmologist may also repair other eye problems, such as cataracts, during the same surgery.

What to expect after Corneal Transplant Surgery

Your surgeon will put an eye patch and eye shield on your eye to protect it.

You will be given some medication (eye drops and sometimes oral medication) to use immediately after the surgery and for a few months during your recovery. This is to help prevent any infection, swelling and pain and corneal tissue rejection.

You will be seen the next day to have your eye checked. Your stitches may or may not need to be removed at a later date, depending upon what type of stitches were used and how your eye heals.

It is important to follow the surgeon’s advice on a gradual return to normal activities. This is to prevent your eye from any injury.

Do not press or rub on your eye.

Bath and shower as normal but be careful not to get water in your eye for at least a month.

Your ophthalmologist will advise you when it is safe to drive again.

It normally takes 1-2 weeks before you would feel comfortable returning to work.

What vision result should I expect?

Your vision result will depend on the reason you had the corneal transplant. Most people will have their vision at least partially restored. It can take some time for your eye to adjust to the new cornea and expect it to take up to a year to eighteen months to achieve your best vision after the surgery. The best visual recovery is normally with a contact lens after 12months.

Once the new cornea has healed, your ophthalmologist will work with you to make adjustments to improve your vision. This may be glasses, contact lenses or in some cases laser eye surgery.

Around 90% of corneal transplants last at least 10 years.

Are there any risks?

A corneal transplant is a relatively safe procedure, but like all surgery it carries some risks and complications:

Eye infection

Cataract (clouding of the eye’s lens)

Glaucoma (increased pressure within the eye ball)

Detached retina (where the tissue lining the back of the eye pulls away from the eye)

Problems with the stitches used to secure the donor cornea

Rejection of the donor cornea

Swelling of the cornea

More about the donor cornea tissue and rejection

The cornea used in corneal transplants comes from deceased donors. There is normally a short wait for cornea tissue to become availabe from the Eyebank in New Zealand. Only healthy donor cornea tissue is used in corneal transplants. Corneas are rigorously checked for disease and infection before being transplanted.

In some people, their body’s immune system recognises the donor tissue as foreign and attacks it. This is called rejection and requires medical treatment. Rejection occurs in around 10% of corneal transplants and if you notice any of the following signs and symptoms of rejection it is important to make an appointment with your ophthalmologist immediately.

Signs and symptoms of donor rejection:

Cloudy or hazy or loss of vision

Eye pain

Redness of the eye

Sensitivity to light

 

Rejection can occur a few weeks after a corneal transplant but it may occur after several months or years.

 

If you have a damaged cornea, your ophthalmologist will be able to discuss your options for improving your vision. Corneal transplant surgery has the potential to restore clear vision.

Phone Bowen Eye Clinic to discuss your management and treatment options with Dr Reece Hall who specialises in cornea treatments. 0800 69 20 20

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