Keratoplasty

A keratoplasty either removes the entire thickness or partial thickness of the damaged cornea and replaces it with healthy donor tissue. The three types of keratoplasty procedures include:-

1. Penetrating Keratoplasty (PK): It is a full-thickness cornea transplant in which all the layers of your cornea get replaced. The surgeon uses an instrument to make this precise circular cut. He/she then places the donor cornea in the opening and sews it with stitches into place. Your doctor may recommend this surgery when you have severe injury or scarring in the cornea. 
2. Endothelial Keratoplasty (EK): In this procedure, the surgeon removes the damaged tissue from the back corneal layers - the endothelium and a thin layer of tissue (Descemet membrane) that protects the endothelium from infections and injuries. There are two types of endothelial keratoplasty. 
   1. Descemet Stripping Endothelial Keratoplasty (DSEK) replaces the endothelium and Descemet membrane above it with the donated endothelium and Descemet membrane attached to the stroma.
   2. Descemet Membrane Endothelial Keratoplasty (DMEK) transplants the endothelium and Descemet membrane, but no supporting stroma. Although more challenging than DSEK, DMEK is commonly used. It uses extremely thin and fragile donor tissue, which often results in quick healing. 

In this procedure, fewer or no stitches are needed. The surgeon uses an air bubble to keep the healthy donor cornea in position. 

3. Anterior Lamellar Keratoplasty (ALK): ALK is used to remove the damaged tissue from the front layers of the cornea, leaving the back endothelial layer in its place. There are two types of ALK procedure.

4. Superficial Anterior Lamellar Keratoplasty (SALK) replaces your cornea’s front (outer) layers, leaving the endothelium and stroma intact. 

5. Deep Anterior Lamellar Keratoplasty (DALK) replaces your cornea’s outer and middle layers, leaving intact the back (inner) layers. 

The surgeon uses stitches to fix the donated cornea in its place. 

Please note: The selection of the treatment approach is based upon your health condition and your surgeon’s opinion. 

1. Before the surgery, you will consult with an anaesthesiologist for a pre-anaesthetic checkup. 
2. Your doctor will review your medical history, answer all your questions and appoint a date for the surgery. 
3. He/she will do some lab tests to check whether you are fit for the surgery. 
4. The doctor will briefly explain the surgical procedure, the hospital stay, and other insurance formalities. 
5. You may need to stop taking some particular medications, like aspirin, at least two weeks before the procedure. 
6. You may have to use antibiotic drops in your eyes the day before the surgery to prevent infection. 

1. On the day of the surgery, the hospital staff will ask you to sign the consent formalities before admitting you to the hospital. 
2. The staff will inform you about the change of clothes and removal of jewellery. 
3. The team will monitor your vitals, including heart rate, breathing, and blood pressure and shift you to the OT room.

1. In the OT room, you will be made to relax on the operating table. 
2. The team will administer an intravenous (IV) line for fluids and medicines in your arms. 
3. The anaesthesiologist will administer either sedation or general anaesthesia based on the results of your PAC. 
4. He/she will apply a numbing medication to your eye. 
5. Someone from the team will monitor your vitals throughout the procedure.
6. The surgeon will perform the procedure and replace your damaged cornea with a healthy donor cornea. 
7. He/she will sew the donor cornea in place with stitches or sutures. For endothelial keratoplasty, the surgeon uses an air bubble instead of stitches to keep the replaced cornea in place. 
8. The surgery typically takes 30 minutes to an hour. 

Recovery at Hospital:-

1. After the surgery, the team will shift you to the recovery room to monitor your vitals. 
2. As keratoplasty is an outpatient procedure, you will be able to go home the same day once your vitals stabilise and the effect of anaesthesia wears off. 
3. The doctor will provide you with home care and follow-up instructions. 

Recovery at Home:-

1. For the first few days after the surgery, it is normal for your eye to be red, irritated, and sensitive to light. 
2. Your surgeon will recommend over-the-counter pain relievers to manage pain. 
3. You will have to wear an eye patch or glasses to protect your eye as it heals.
4. Do not rub or press your eye and avoid activities that can directly hit your eye. 
5. For endothelial keratoplasty, you will have to lie on your back with your face up for a few days after the surgery. 
6. You might be able to return to work after a few days or weeks.
7. If your job involves strenuous activities, you should wait for 3 to 4 months.
8. Avoid dusty or smoky places to prevent your eyes from irritation. 
9. Do not drive until your provider allows it. 
10. The duration of recovery depends upon the type of surgery. Endothelial keratoplasty tends to have a faster recovery period.

1. You will usually have your first follow-up visit within a day or two of your surgery. 
2. During the visit, your doctor will remove your eye patch and check the healing of your eye. 
3. The doctor will also prescribe eye drops to control infection (antibiotics), pain, swelling, inflammation, and prevent rejection (corticosteroids). 
4. He/she will not remove the stitches for penetrating and anterior lamellar keratoplasty for several months. 
5. The doctor will appoint further follow-up visits several times during the first couple of weeks. 

Like any other surgery, keratoplasty has some risks, including:-

1. Cornea rejection by the immune system
2. Infections in the cornea or inside your eye
3. Glaucoma (increased pressure within the eyeballs)
4. Bleeding
5. Leakage of fluid from the cornea
6. Retinal detachment or swelling
7. Visual acuity problems
8. Problems with the stitches

Cornea rejection may require immediate medical treatment or another cornea transplant. Call your healthcare professional if you experience the following signs and symptoms:-

1. Eye pain
2. Redness in eyes
3. Loss of vision
4. Cloudy vision
5. Sensitivity to light