Dr. Orwa Nasser MD MPH - Cornea Transplant

Cornea Transplant

A cornea transplant, also called keratoplasty, is a surgical procedure that replaces part or all of a damaged or diseased cornea with healthy donor corneal tissue. The cornea is the clear dome-shaped front surface of the eye that helps focus light and protect internal structures. Cornea transplantation may restore vision, relieve pain, treat infection, or repair structural damage when other treatments are not sufficient. The cornea does not contain blood vessels, which lowers the risk of immune rejection compared to many other transplanted tissues.

Why Is a Cornea Transplant Done: A cornea transplant may be recommended when the cornea becomes cloudy, scarred, swollen, or structurally weakened.

    ·    Fuchs dystrophy.

    ·    Corneal scarring from infection or trauma.

    ·    Corneal ulcer complications.

    ·    Corneal thinning or perforation.

    ·    Corneal dystrophy affecting vision.

    ·    Keratoconus.

    ·    Complications from previous eye surgery.

Types of Cornea Transplant:

·    Penetrating Keratoplasty: Penetrating keratoplasty is a full-thickness transplant that replaces all layers of the cornea. It is typically performed when damage involves the entire corneal thickness and layers.

·    Lamellar Keratoplasty: Lamellar keratoplasty replaces only specific layers of the cornea while preserving healthy tissue.  Partial-thickness procedures often allow faster recovery and lower rejection risk.

o   DALK (Deep Anterior Lamellar Keratoplasty) replaces the anterior layers and preserves the endothelium.

o   DSEAK (Descemet’s Stripping Endothelial Keratoplasty) and Descemet’s Membrane Endothelial Keratoplasty replace diseased endothelial layers.

What Happens During the Procedure:

·    Cornea transplant surgery is usually performed under local anesthesia with sedation. In some cases general anesthesia is preferred.

·    The damaged portion of the cornea is removed carefully.

·    Healthy donor tissue is shaped precisely to fit the recipient corneal opening.

·    The donor tissue is secured with fine sutures or air support depending on the technique.

·    The procedure generally takes one to two hours.

Recovery and Healing:

·    An eye shield may be placed immediately after surgery.

·    Vision is typically blurry during the early postoperative period.

·    Steroid eye drops are prescribed to reduce inflammation and prevent rejection.

·     Antibiotic drops may be used initially to prevent infection.

·    Sutures may remain in place for months in penetrating keratoplasty.

·    Complete visual recovery may take several months to one year.

·    Regular follow-up visits are essential to monitor healing and detect complications early.

Risks and Complications:

    ·    Graft rejection.

    ·    Infection.

    ·    Increased intraocular pressure.

    ·    Astigmatism due to suture tension.

    ·    Recurrence of original corneal disease.

    ·    Delayed wound healing.

    ·    Early treatment of rejection significantly improves outcomes.

Prognosis:

·    The long-term prognosis depends on the underlying condition and type of transplant.

·    Many patients experience significant visual improvement.

·    Partial-thickness procedures often provide faster recovery.

·    Glasses or contact lenses may still be required after healing.

Prevention: Early diagnosis and management of corneal disease may delay the need for transplantation. Following postoperative instructions carefully helps protect graft health.

When Should I See My Healthcare Provider? Contact your eye specialist if you experience redness, pain, light sensitivity, or decreased vision after surgery.

When Should I Go to the Emergency Room? Seek emergency care if you develop severe sudden vision loss, significant trauma, or severe eye pain.

What Questions Should I Ask My Healthcare Provider?

    ·    What type of keratoplasty is best for me?

    ·    What is the expected recovery timeline?

    ·    What are signs of graft rejection?

    ·    How long will I need steroid drops?

    ·    Will I require glasses after surgery?

Key Takeaways:

    ·    Cornea transplant replaces damaged corneal tissue with donor tissue.

    ·    It may restore vision or relieve pain.

    ·    There are full-thickness and partial-thickness techniques.

    ·    Recovery may take several months.

    ·    Early detection of rejection is essential.