Cornea Transplant

A cornea transplant also known as Keratoplasty, is a surgical method used to replace the cornea with corneal tissue. Corneal tissue is obtained from a donor who wants to donate it. The cornea is a dome-shaped transparent part of the eyes. It is the site from where light enters the eyes. 

Corneal diseases are the fifth leading cause of losing eyesight in the world. Cornea transplant helps in restoring vision and is, therefore, the most common and most successful method to treat corneal disease. It also improves the appearance of the eye's damaged and diseased corneal part. It is done as an outpatient procedure.

 

Along with treating vision loss, Cornea transplant surgery also improves the following medical conditions:-

1. Keratoconus (when the cornea becomes thin and bulges outward like a cone)
2. Deposition of amyloid in eyes that may lead to vision loss
3. Degeneration of the innermost corneal layer
4. Swelling of the cornea
5. Scaring or clouding of the cornea
6. Corneal ulcers that are not managed with the medicines
7. Any complications caused by previous eye surgery
8. Corneal lacerations
9. Fuchs' dystrophy (Corneal swelling and thickening resulting in cloudiness due to accumulation of fluid)

Keratoplasty is of the following types:

1. Penetrating keratoplasty
   1. Eyes are anaesthetized.
   2. An eyelid speculum (a device used to stretch the muscles around the eye) is inserted in the eye.
   3. The surgeon makes a precise cut around the entire thickness of the cornea to remove small button-sized cornea tissue.
   4. The donor cornea that is already cut is then fitted into the incised slot. Then the new cornea is fixed there using sutures.
   5. Sutures are removed later during follow-up appointments.
2. Endothelial keratoplasty
   1. About half of the cases of cornea disease are related to the cornea's innermost layer.
   2. After anaesthetizing the patient, the doctor removes a single layer of the cell (endothelium) and a layer that protects it. Then the doctor replaces it with donated endothelium. 
3. Anterior lamellar keratoplasty (ALK)
   1. The type of approach used for ALK depends upon the degree of corneal damage. 
   2. Superficial anterior lamellar keratoplasty (SALK) is used to replace only the cornea's frontal layer.
   3. Deep Anterior lamellar keratoplasty (DALK) is used for treating deeper extended damage.

1. Your doctor and anaesthesia team will review your medical history. Ask the doctor if you have any questions regarding the procedure. 
2. Do not forget to tell the doctor about the medicines you are currently taking, including supplementation and over-the-counter drugs. 
3. The doctor may recommend not to take any fluid and food after midnight or before surgery.
4. The doctor may advise you to bring anyone with you who can drive you back home after surgery.

1. Always plan to arrive at the hospital at a scheduled time. Try to reach at least 2 hours before surgery. The staff will prepare the patient for surgery. They will:-
2. Ask the patient to wear a gown, cap, and a paper slipper provided by the hospital.
3. Check the patient's blood pressure, heart rate, and breathing rate.
4. Perform a complete eye examination

 

 

You may expect the following during the surgery:

1. The procedure of keratoplasty takes approximately one to two hours.
2. Most probably, you will remain awake during the whole surgical procedure. 
3. You will remain under the influence of a sedative during the entire procedure. It will help you to relax during surgery.
4. The surgeon will inject a dose of local anaesthesia around the eyes. It is done to prevent your eye muscles from moving.
5. The surgery is done with the help of a microscope. 
6. The surgeon removes the cornea using a cutting instrument known as a trephine.
7. A new cornea is placed in the empty slot.
8. The cornea is fixed there using a very fine suturing thread. It is removed later after the eyes get healed completely.

You may expect the following after the cornea transplant surgery:

1. You will remain in the recovery room for about one or two hours.
2. You may be able to be home on the same day of the surgery.
3. For the first few days, your eyes might remain red. It may remain irritated and sensitive to light. 
4. The surgeon may prescribe you some pain relievers to relieve pain post-surgery. 
5. The doctor may give steroid eye drops to prevent inflammation and antibiotics from preventing infection. You need to administer the eye drops strictly as directed. 
6. The surgeon may provide you with an eye patch. You have to wear it for a few weeks to protect your eyes.

First follow-up appointment

You may expect the following during the first few follow-up appointments:

1. Adequate eye care plays a vital role in desired outcomes and recovery. 
2. The best way to prevent postoperative complications is to go for follow-up appointments regularly.
3.  The sutures may get cut during the follow-up appointments. 
4. In addition, the doctor may provide some painkillers to relieve the pain caused after the surgery.
5. The doctor will test if the transplanted cornea functions fine and if there are no complications at follow-up appointments.
6. Vision might be different from the previous eyes. This difference can be corrected by using a contact lens or eyeglasses. 
7. After the transplantation, vision may change rapidly. Therefore it is essential to visit eye doctors regularly.

The majority of corneal transplant surgeries are not urgent, and thus their delay may not cause any complications. However, the vision of these patients, waiting for the transplant, does not improve without a corneal transplant. Therefore, the patients may have a problem driving, loss of employment or not fit for particular jobs, anxiety and depression, headaches, and risk of injury. However, once the matching donor is found, the patient should undergo a corneal transplant as soon as possible.

Immediately consult a doctor if you have started experiencing any following signs and symptoms. 

1. Pain in eyes
2. If there is redness in the eyes
3. If you experience hazy or cloudy vision
4. Bleeding from the site of the incision
5. Swelling in the corneal area
6. If there is an increase of pressure inside the eyeballs, you are experiencing pain, gradual vision loss, or the sudden appearance of floaters.