A corneal transplant, also called 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, over half a million corneal transplants have been performed in the United States. Today, about 40,000 corneal transplants are performed in the United States 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. One of the major factors is the nature of the cornea itself. Because the cornea contains no blood vessels, the transplant patient's antibodies and white blood cells do not circulate in the donated cornea. This minimizes the recipient's immune response and reduces the risk of rejection.
The success of corneal transplants depends upon the generosity of donors. If corneal transplants and other organ transplant programs are to continue to save 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 the nurse and anesthetist. You will be given a hospital gown to change into, and the nurse will set up an IV to give you fluids and medicine. The anesthetist will give you the anesthetic to be used during your surgery. At first, you will not be "put under." Instead, you will be sedated. You will be drowsy and relaxed but you will not be able to feel anything. Next, you will then be wheeled into the operating room, where you will be given a general anesthetic. The general anesthetic will last for about five minutes while you receive a retrobulbar anesthetic. This is a special kind of anesthesia that only affects your eye. You will be unable to move the eye or see out of it, and you will not feel any pain. Once the retrobulbar anesthetic has been administered, we will wake you from the general anesthetic. You will still be sedated, so you will feel relaxed during the surgery.
The first step in the surgery is the removal of your corneal tissue. A special device known as a trephine is used to remove a circular "button" of tissue from your cornea. Your doctor then shapes the donor corneal tissue and carefully places it on your cornea. (Before your surgery, the donor tissue was carefully inspected by your doctor.) The new corneal tissue is held in place with very fine sutures, which stay in place for up to year after surgery. Your doctor rehydrates the eye with a special solution and closely checks the cornea to ensure there are no leaks. A patch is placed on your eye to protect the new cornea, and your surgery is over.
If necessary, we can do additional surgical procedures at the same time as a corneal transplant. The most common combination is removal of a cataract and insertion of an intraocular lens. Our doctors can also do other procedures, such as glaucoma surgery. The corneal transplant is usually done after the other procedure is finished.
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 doctor recommends. You can expect to use it for two to three months.
- Use all your eye drops as directed. If you have problems with any eye drops, contact your doctor. Do not stop using eye drops without checking with the doctor first.
- Do not drive until you have your doctor'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 doctor will remove your eye patch and check your vision. 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 to understand that your recovery will go at its own pace. Depending on how well your cornea heals, your stitches will be removed any time between three months to 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 sensitivity to light, persistent redness or changes in vision. Report any of these problems to your doctor immediately.
Other potential complications of the surgery 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 still need glasses or contact lenses after surgery for the best vision.
Anesthesia also has some risks. Your anesthetist will talk with you about these before surgery.
Knowing about the risks of surgery can be intimidating, but corneal transplant surgery also has considerable benefits. A cloudy or scarred cornea can make your vision much worse. When it is replaced with a clear cornea, the world of light and color is restored. Many patients are delighted to get back to activities they could not do because of poor vision.