A corneal transplant, also known as a corneal graft or keratoplasty, is often the final attempt to preserve sight when a cornea has been badly damaged or scarred. First developed in 1905, corneal transplants became a reliable form of corneal surgery in the early 1950s. Since that time, more than half a million corneal transplants have been performed in the United States, with about 40,000 done each year. With a success rate of over 90%, corneal transplants have the best outcomes of any transplant surgery.
There are many reasons for the success of corneal transplants, but one of the major factors is the nature of the cornea itself. Because the cornea does not contain blood vessels, the patient's antibodies and white blood cells do not circulate in the donated cornea. This minimizes the recipient's immune response, reducing the risk of rejection.The success of corneal transplants also depends upon the generosity of donors. If corneal transplants and other organ transplant programs are to continue saving vision and lives, it is vitally important that everyone sign the organ donor form on their driver's license.
The Corneal Transplant Procedure
When you arrive at Casey Eye Institute for your corneal transplant, enter through the front doors and go to the surgery reception desk on the 6th floor. Our receptionist will be expecting you.
Prior to your surgery, you will be taken to the preparation area, where you will meet your nurse and anesthetist. You will be given a hospital gown, and the nurse will give you an IV. This will give you medication and fluids during the surgery. The anesthetist will give you the anesthetic to be used during your surgery. At first, you will not go to sleep. You will be sedated, so you feel sleepy and relaxed, and will not be able to feel any discomfort. Next, we will take you to the surgery suite, where you will be given a general anesthetic. This will last about five minutes. While the general anesthetic is working, the anesthetist will give you a special kind of anesthesia that affects only your eye. You will not be able to move your eye or see out of it, and will not feel any pain. Once this anesthetic has been given, we will wake you from the general anesthetic. You will still be sedated, so you will feel relaxed during your corneal transplant.
The first step in the surgery is the removal of your corneal tissue. Your doctor will use a special device called a trephine to remove a circular "button" of tissue from your cornea. The doctor will then shape the donor cornea and carefully place it on your eye. (Before your surgery, the donor tissue was carefully inspected by your doctor.) The new corneal tissue is held in place with very fine stitches, which stay in place for up to a year. After the new cornea is placed on your eye, your doctor will rehydrate your eye with a special solution and check to make sure there are no leaks. After we cover your eye with a protective patch, your surgery is over.
If necessary, your doctor can do other procedures at the same time as your corneal transplant. The most common combination is removing a cataract and placing an intraocular lens in your eye. Our doctors can also do procedures such as glaucoma surgery. In these situations, the transplant is usually done after the other procedure is complete.
INTRALASE ENABLED KERATOPLASTY (IEK)
Recently doctors have started using lasers to remove the damaged cornea and shape the healthy donor tissue. This type of corneal transplant is called IntraLase enabled keratoplasty (IEK). Using a laser allows the surgeon to do more precise surgery. Corneal tissue is made up of thin layers, and the laser can trim each layer so the new cornea fits your eye better. This precise matching can help your eye heal faster after surgery. You may also be able to see better when your eye is healed. IEK is not for everyone. If you have glaucoma or severe corneal scarring, or your cornea is completely cloudy (opaque), you may need to have a conventional corneal transplant.
After surgery, you will be taken to the recovery area where you will be monitored by the nurse. When the nurse is satisfied that you are ready to go home, you will be able to leave. You will be given pain pills, but you will probably not need to use them; most corneal transplant patients do not experience pain after surgery.Once you go home, it is important that you follow your post-operative instructions carefully. These include:
- Wear your eye shield at night for as long as your surgeon recommends. You can expect to use it for two to three months.
- Use all eye drops as directed. If you have problems with any eye drops, contact your surgeon. Do not discontinue use without checking with the surgeon first.
- Do not drive until you have your surgeon's approval.
- Do not rub your eye.
- Avoid heavy lifting.
- Stay out of swimming pools and hot tubs.
- Keep your eyes closed in the shower.
- Avoid dust, smoke (including cigarette smoke) and other eye irritants.
The day after surgery, you will need to return to the Casey Eye Institute. Your patch will be removed and your vision will be checked. You can expect to have blurry vision because of the dilation drops and ointments in your eye. Your eye will probably be red, teary and sensitive to light. The stitches on your cornea will also be visible.
Although corneal transplants do not cause pain, some patients do notice discomfort in the first week after surgery. If this happens, you can expect the discomfort to peak in the first week. The most common complaints are watery eyes or a scratchy feeling in the eye.
Your surgeon will want to see you frequently after your surgery, so you can expect to come back to the Casey Eye Institute three days after surgery and again at two weeks, four weeks, three months and then as directed.Because corneal healing varies greatly from one person to another, it is important not to have preconceptions about your own recovery. Depending on how well your cornea heals, your stitches will be removed anytime between three months and one year after surgery. Your vision will return gradually, often taking six to 12 months to stabilize.
Risks and Benefits of Corneal Transplants
Although corneal transplants are highly successful, there are some risks associated with the procedure. One of the most significant risks is rejection, although this is not common and can often be halted with prompt treatment. Warning symptoms include persistent discomfort, excessive light sensitivity, persistent redness or changes in vision. Report any of these problems to your doctor immediately.
Other potential complications include infection (endophthalmitis), which can be treated with antibiotics; retinal detachment, which can usually be surgically repaired; and glaucoma, which can be treated with eye drops.
Even a successful corneal transplant does not guarantee perfect vision. You may need to wear glasses or contact lenses after surgery to get the best vision.
Anesthesia also has some risks. Your anesthetist will explain these to you before surgery.
Potential risks can be intimidating, but these are balanced by the considerable benefits of the surgery. A cloudy or scarred cornea can make your vision significantly worse. When you receive a new cornea, the world of light and color is restored. Many patients are delighted to get back to activities they could not do when their vision was poor.