Cornea Transplant Surgery

What is Cornea Transplant Surgery?

The cornea is the clear transparent window at the front of the eye. Through it, light enters the eye so an image can be seen.

Diseases of the cornea or injuries can result in the shape of your cornea changing. This can lead to blurred or distorted vision. Some people also report seeing haloes or glare because of a diseased cornea.

Corneal transplants replace your diseased or damaged cornea with a healthy cornea from a donor. If you haven’t had an improvement in your vision with glasses, contact lenses, or with medical or laser treatment, you could benefit from a corneal transplant.

Reasons for cornea transplant surgery

Cornea transplant surgery can significantly improve your vision and, in some cases, reduce eye pain. You may need a corneal transplant to help relieve other symptoms associated with your condition.

Your cornea may have become damaged or changed due to:

  • Keratoconus
  • Fuchs’ endothelial dystrophy
  • Corneal perforation (small hole in the cornea)
  • Thinning or tearing of the cornea
  • Keratitis (also known as a corneal ulcer)
  • Bullous keratopathy (a blister-like swelling of the cornea)
  • Corneal dystrophies – such as lattice, granular and macular
  • Damage due to previous cornea surgery
  • Corneal swelling
  • Corneal scars

Very rarely, less than 1 in 5000 patients will need corneal transplant surgery due to laser eye surgery complications. Learn more about this in our blog, ‘Is laser vision correction surgery safe?’.

 

During the procedure

Generally, on the day, we will run any final tests we need to do, and you will be under anaesthesia for the procedure.

We will remove your damaged cornea and replace it with donated healthy corneal tissue. It should take no more than 2 hours.

Learn more about the corneal transplant procedure in our blog, ‘A surgeon’s guide to corneal transplant surgery’.

Types of corneal transplant

The cornea is divided into several layers which includes a thin front layer, a thick middle layer and a thin back layer. Given recent advances in corneal transplantation techniques, it is now possible to replace individual layers or the whole cornea.

The most commonly performed corneal transplants are divided into partial thickness (DALK or EK) and full thickness (PK).

    In DALK, the front 90% of the cornea (front and middle layer) is replaced with the front 90% of a healthy donor cornea. The back layer remains untouched. The advantage of this is greater structural integrity and reduced risk of transplant rejection compared to full thickness transplant.

    The commonest reason for doing a DALK is keratoconus. Other common indications are corneal scars and corneal dystrophies.

    In some corneal diseases only the back layer of the cornea is affected causing the cornea to be cloudy. In EK, the back layer of the diseased cornea is replaced with the back layer of a healthy donor cornea to treat the cloudiness. The healthy front and middle corneal layers remain untouched. EK patients have faster visual recovery and maintain the original shape and integrity of the cornea compared to full thickness transplants.

    The main indications for doing an EK are Fuchs Endothelial Dystrophy and Bullous Keratopathy (after anterior segment surgery).

    In PK, the full thickness of the cornea is replaced with a donor cornea. This is usually undertaken when all the layers of the cornea are diseased.

Aftercare

In most cases, you will be able to go home on the same day as the procedure, particularly if you have a partial-thickness transplant. If you have had a full-thickness cornea transplant, you may need to stay overnight in the hospital for observation and recovery.

When you leave, you will need someone to help drive you home. This is because your vision will be limited, and you will still be recovering from the anaesthetic.

You may experience some discomfort for a few days after the procedure. You must wear an eye patch or plastic shield for 1-3 days. Once you stop using the eye patch, you may still experience some blurriness, but this is normal.

You may be prescribed eye drops or oral medication by your doctor to help heal your cornea and prevent infection or rejection. Follow our instructions to gain the best results and avoid complications.

Some important things to remember during recovery include:

  • Do not rub your eyes
  • Avoid strenuous activity and heavy lifting during the first week of surgery
  • Avoid smoky or dusty places
  • If your eye(s) is sensitive to light, wear sunglasses
  • Avoid contact sports and swimming until you have been given clear advice that it’s safe
  • Be careful not to get water in your eye for at least a month
  • Do not drive until your specialist tells you otherwise

The success of your procedure depends on the underlying cause of the cornea damage and your immune system’s acceptance of the donor transplant. We will discuss your outcome pre- and post-surgery and decide whether revision surgery will be necessary during recovery.

To ensure success after surgery, you will also need to wear glasses and/or contact lenses for good vision in the long term.

Risks

Cornea transplant surgery is relatively safe. The likelihood of developing serious complications from it is minimal. However, as with any surgery, there are some risks.

The risks include:

  • An eye infection
  • Problems with the stitches securing the donor cornea
  • Retinal problems, such as swelling or retinal detachment
  • Fluid leaking from the cornea
  • Clouding of the lens or cataracts – this will require cataract surgery
  • Bleeding

 

Complications

Because a donor cornea is used to replace your damaged cornea, there is a risk of rejection. 

Rejection happens when your body’s immune system does not accept the new transplant. It recognises that the donor transplant is not a part of your body and attacks it. It can occur from a few weeks after your procedure to several years, but typically within a few months.  

If you notice the following symptoms after your transplant surgery, we recommend you seek emergency specialist advice about your condition. Please contact us if you are experiencing: 

Another possible surgical complication is developing another condition as a result of your procedure. These include:  

  • Your original eye disease returning 
  • Astigmatism 
  • Inflammation of the middle layer of the eye (Uveitis) 
  • Infection because of surgery wounds 
  • Increased pressure in the eyeball (glaucoma)   
  • Wounds from surgery reopening  

Your consultation

During your consultation, you will have a complete assessment of your eye. You may also have scans done to determine which layer(s) of your cornea are affected. Mr. Ayoub will discuss your treatment options with you and guide you on the choice of transplant that is best suited to your corneal problem.

Mr. Ayoub is highly skilled in performing the different types of corneal transplants and will go through the steps of surgery and the recovery process from the surgery with you in detail during the consultation.

FAQs

    While you are often awake during corneal transplantation, you can ask for a general anaesthetic to put you to sleep.

    To keep the transplant in place and to ensure it heals correctly, you will have sutures placed in the eye.

    Stiches usually remain in the eye after surgery and are non-dissolvable, so you will have to get them removed by a medical professional.

    Usually, stiches will be removed after a year. Sutures can occasionally break spontaneously. If you notice a persistent feeling of something in the eye, you should contact us immediately so we can address this. If a suture has broken, it needs to be removed to avoid the risk of infection and graft rejection.

    You can have more than one corneal transplant, usually with good results. However, the overall rejection rates for repeated transplants are slightly higher than for the first transplant. 

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