The cornea is the clear layer on the front of your eye that aids in the focus of light so you can see clearly. If it becomes damaged, you may need to replace it.
Your cornea will be removed in whole or in part by the surgeon and replaced with a healthy layer of tissue. The new cornea was created by people who chose to donate their corneas when they died.
A cornea transplant, also known as Keratoplasty, can restore vision, relieve pain, and possibly improve the appearance of your scarred cornea.
Who Needs One?
Light rays passing through a damaged cornea can become distorted, altering your vision.
A corneal transplant can help with a variety of eye problems, including:
*Scarring of the cornea as a result of an injury or infection
*Corneal ulcers, also known as “sores,” are caused by an infection.
*A medical condition that causes your cornea to swell (keratoconus)
*Corneal thinning, clouding, or swelling
*Fuchs’ dystrophy and other inherited eye diseases
*Problems caused by a previous eye surgery
Your doctor will advise you on the best procedure for your specific condition.
Full Thickness Corneal Transplant
All of the layers of your cornea are replaced if your doctor performs a penetrating keratoplasty (PK). The surgeon uses hair-thin stitches to sew the new cornea onto your eye.
If you have a severe corneal injury or significant bulging and scarring, you may require this procedure.
It has the longest recovery time.
Partial Thickness Corneal Transplant
The surgeon uses air to lift and separate the thin outside and thick middle layers of your cornea during deep anterior lamellar keratoplasty (DALK), then removes and replaces only those layers.
This procedure may be performed on people who have keratoconus or a corneal scar that has not affected the inner layers.
This procedure requires less healing time than a full thickness transplant. Because your eye is not opened, the lens and iris are unlikely to be damaged, and there is less chance of infection inside your eye.
Endothelial Keratoplasty
Each year, approximately half of the people who require cornea transplants have a problem with the endothelium, the cornea’s innermost layer.
This type of surgery is frequently used to treat Fuchs’ dystrophy and other medical conditions.
The most common type of endothelial keratoplasty is Descemet’s stripping endothelial keratoplasty (DSEK or DSAEK). The endothelium, which is only one cell thick, and the Descemet membrane just above it are removed by the surgeon. They are then replaced with a donated endothelium and Descemet membrane that is still attached to the stroma (the thick middle layer of the cornea) to help him handle the new tissue without damaging it.
Descemet’s membrane endothelial keratoplasty (DMEK) transplants only the endothelium and the Descemet membrane, with no supporting stroma. The donor tissue is very thin and fragile, making it more difficult to work with, but healing from this procedure is usually faster, and the end result vision is often slightly better.
If the surrounding cornea appears healthy enough to provide cells to fill in the removed area, a third option for selected people with Fuch’s dystrophy is simple removal of the central part of the inner membrane without a transplant.
Because recovery is easier with these surgeries, they are good options for people who have only inner layer corneal damage.
What’s the Surgery Like?
Your doctor will most likely perform an exam and some lab tests prior to your surgery to ensure that you are in good general health. Certain medications, such as aspirin, may need to be stopped a few weeks before the procedure.
Antibiotic drops in your eye are usually required the day before your transplant to help prevent infection.
These surgeries are typically performed as outpatient procedures under local anaesthesia. This means you’ll be awake but woozy, the area will be numb, and you’ll be able to leave the hospital the same day.
The entire procedure will be performed under a microscope by your doctor. It usually takes between 30 minutes and an hour.
Recovery
After that, you’ll most likely need to wear an eye patch for at least a day, possibly four, until the top layer of your cornea heals. Your eye will most likely be red and light sensitive. It may hurt or feel sore for a few days, but some people are not bothered.
Your doctor will prescribe eye drops to reduce inflammation and the likelihood of infection. They may also prescribe other pain relievers. They’ll want to check your eye the day after surgery, several times over the next few weeks, and a few more times over the next year.
For transplant procedures that use a gas bubble inside the eye to help position the transplanted tissue, such as DSEK and DMEK, the surgeon may ask you to lie flat during the day and sleep flat on your back at night for a few days.
After your surgery, you must safeguard your eye from injury. Follow your doctor’s advice exactly.
Because your cornea does not obtain any blood, it heals slowly. If you required stitches, your doctor will remove them at the office several months later.
Complications that could occur
A corneal transplant is a relatively safe procedure, but it is still surgery, so there are risks.
The body’s immune system attacks donated tissue in about one out of every ten transplants. This is known as rejection. Most of the time, it can be reversed with eye drops. Because so little donor tissue is used for DSEK and especially DMEK, the risk of rejection is much lower.
Other possible outcomes include:
- Infection
- Bleeding
- Increased intraocular pressure (called glaucoma)
- Lens clouding of the eye (called cataracts)
- Corneal enlargement
- When the back inside surface of your eye pulls away from its normal position, you have a detached retina.
Results
Most people who have a cornea transplant have at least some of their vision restored, but each case is unique. It could take several weeks to a year for your vision to improve completely. It is possible that your vision will deteriorate before it improves.
Because the transplanted tissue will not be perfectly round, your glasses or contact lens prescription may need to be adjusted to include astigmatism correction.
You should see your eye doctor once or twice a year after the first year. Donated tissue typically lasts a lifetime.
The doctors at Dr Kamdar Eye Hospital specialise in LASIK, cataract, cornea, retina, and glaucoma treatments.
The hospital has cutting-edge medical facilities that pair cutting-edge technology with the most experienced ophthalmologists. Our goal is to help you realise your best vision.
Please call or visit Dr Kamdar Eye Hospital for more information or to schedule an appointment with a consultant.