Corneal Transplant
The corneal transplant procedure has evolved over the last century and is now routinely performed as an outpatient procedure. Thousands of patients benefit each year from this procedure, performed by experienced cornea specialistslike Dr. John Goosey. The corneal transplant comes in various forms, with specific techniques tailored to patient’s disease. One exciting innovation in corneal transplantation is the DSAEK technique, which offers more precise and effective outcomes.
Before sharing more details about the procedure, it’s important to note that Lonardo da Vinci famously said, ‘The eyes are the window of the soul’, da Vinci was fascinated by the dynamics of vision, and considered sight “the best and most noble” of our senses. Anatomically speaking, the cornea is the window to the eye, and when it becomes damaged, a corneal transplant is often needed to restore vision.
What Is The Cornea?
The cornea is the transparent, protective layer at the front of the eye. Light passes through the cornea before the visual process can occur. When the cornea is altered by trauma or disease, it becomes cloudy, leading to impaired vision. In such cases, a corneal transplant is necessary to replace the damaged tissue with a clear donor cornea, helping restore sight.
When is a Corneal Transplant Necessary
In cases where the cornea is damaged by disease or injury, and light cannot pass through effectively, vision becomes reduced. A corneal transplant replaces the damaged cornea with a clear donor cornea. This delicate microsurgical procedure is often performed to treat conditions such as:
- Fuchs’ Endothelial Dystrophy
- Pesudophakic Bullous Keratopathy
- Keratoconus
- Cornel Scars and malformed cornea from previous surgeries like LASIK or RK
For some patients, alternative procedures such as anterior lamella keratoplasty (ALK) can be used to avoid the risks of corneal endothelial graft rejection.
The corneal transplant procedure is used to visually rehabilitate patients with Fuchs’ Endothelial Dystrophy and psuedophakic bullous keratopathy in a fraction of the time required by the older, more conventional corneal transplant procedure known as PKP. Other exciting innovations also have occurred in ALK (anterior lamellar keratoplasty). ALK is used to visually rehabilitate patients with keratoconus, corneal scars, and mal shaped corneas following RK or LASIK surgery. The beauty of this procedure is that the patients can be rehabilitated with no fear of corneal endothelial graft rejection.
More Information – The information below has been provided with permission from the National Keratoconus Foundation (NKCF)
More on Corneal Transplant Surgery
Once you decide to undergo a corneal transplant, it helps to know what to expect during the procedure and the recovery process. This knowledge can reduce anxiety and help you feel more in control. Here’s what you should know:
Insurance: Contact your insurance company to confirm coverage, including any pre-authorization requirements. Ask what aspects of the surgery and post-operative care will be covered, including follow-up visits and prescription lenses.</li>
Pre-Surgery: A few days prior to surgery, you’ll undergo a general medical exam and routine lab tests to ensure you’re healthy enough for the procedure. You should not use aspirin for 2 weeks prior to surgery, since it tends to cause bleeding during surgery. Antibiotic drops are generally started one day before surgery to protect the eye from infection.</p>
The Procedure: On the day of surgery, your eyelids will be cleaned, and a sterile drape will be applied. You may receive oxygen via a small tube near your nose, and many patients doze off during the procedure. A trephine (a circular cutting tool) removes the damaged portion of your cornea, and a matching “button” from the donor cornea is then stitched into place using extremely fine nylon sutures.
Post-Surgery Care: After the procedure, a patch and shield are applied to protect the eye. You’ll be monitored in a recovery room before being discharged. Pain is usually mild and can be managed with Tylenol. It’s important to rest for the remainder of the day.
In the operating room, your eyelids are carefully washed and covered with a sterile plastic drape. Oxygen is occasionally provided by a plastic tube placed near the nose. Patients often doze off during the operation, and most are left with vague recollections of a short procedure, although some remember all of it.
The entire procedure is done under a microscope. A circular cookie cutter-like instrument, called a trephine, is used to remove the center of the diseased cornea. A “button” of similar size is cut from the donor cornea. This donor tissue is then sewn in place with extremely fine nylon sutures.
At the end of the procedure, a patch and shield are applied to protect the eye. You will then be taken to the recovery room to wait until you are fully awake before being discharged.
After surgery, you should rest the remainder of the day. Post-surgical pain varies from person to person. Typically, there is either no pain or only slight soreness for a few days which is usually relieved by Tylenol. Discuss pain management with your surgeon before the surgery and fill prescriptions to have available if needed afterwards.
What to Expect During Recovery
The operated eye will be patched until the surface layer of the cornea heals, usually within one to four days. Your doctor will remove the patch at a follow-up visit and provide detailed post-surgery instructions on wound care. Bring someone with you to this appointment to help ensure you fully understand the instructions.
Protecting Your Eye: Using the prescribed eye drops as directed is crucial for your recovery—ensure you know the exact schedule for their use. Schedule your follow-up appointment, typically within three to seven days after your corneal transplant, and make sure you understand how to reach your doctor if you have any concerns or issues. Once the patch is removed, you’ll need to take extra precautions to prevent accidental injury to the eye. You may be advised to wear glasses during the day and a protective shield at night. It’s important to avoid contact sports and any activities that could cause trauma to the eye for several months.
Healing Time: Because the cornea lacks blood vessels, it heals slowly. Sutures are typically left in place for 3 months to a year and, in some cases, are left in permanently if vision is stable. These sutures are made of nylon and are extremely fine—about 1/3 the thickness of a human hair. They may be adjusted or removed during follow-up visits to optimize vision.
Long-Term Care: Vision gradually improves as the new cornea heals, with many patients experiencing useful vision within a few weeks. Full recovery can take several months to a year. Steroid eye drops are used post-surgery to prevent rejection of the donor cornea, and some patients may need to continue these drops indefinitely.
After the patch is removed, it is important to protect the eye from accidental bumps or pokes. Typically, for several months after surgery, patients wear glasses during the day and a metal or plastic shield at night to protect the eye from trauma while sleeping. Because the new cornea is delicately sutured in place, a direct blow to the eye must be avoided. Contact sports are discouraged after corneal transplant. Otherwise, normal activity can be resumed within a few days. After the first day, shaving, brushing teeth, bathing, light housework, bending over, walking, reading, and watching TV will not hurt the eye.
Because the cornea has no blood supply, the transplant heals relatively slowly. Sutures are left in place for three months to one year, and in some cases if the vision is good, they are left in permanently. The sutures are buried and therefore don’t cause discomfort. Occasionally, they do break and then need to be removed. Often, they are removed, adjusted or loosened to improve vision. Suture adjustment and removal are simple, painless office procedures.
The sutures used in corneal transplants are made of a monofilament nylon and are quite small (22 microns – 1/3 the thickness of a human hair). There are many different suturing patterns used by surgeons the world over. All of these suture techniques are effective. Some are utilized because of the surgeon’s preference and training. Other suturing techniques are employed depending on the specific problem for which the transplant is being done. In some cases, surgeons will use 16 individual (“interrupted”) sutures; others use a continuous (“running”) suture, which is much like a hemstitch. Still others routinely use a combination of both types. In all cases, the results are more or less equivalent.
Vision gradually improves as the new cornea heals. There is often useful vision within a few weeks. However, in some cases, it may take several months to a year for full vision to develop.
To prevent rejection of the new cornea, steroid eye drops are used for several months after surgery. In some cases, low dosage steroid drops are continued indefinitely. Unlike oral steroids, steroid eye drops cause no side effects elsewhere in the body. Occasionally other eye medications are necessary.
Signs of Complications
It’s crucial to contact Dr. Goosey’s office immediately if you notice an unusual symptoms such as”
R: Redness
S: Sensitivity to Lights
V: Vision Loss
P: Pain
If you experience flashing lights, floaters, or loss of peripheral vision, report these symptoms immediately.
Follow-Up Care
Postoperative care is extremely important to the success of your corneal transplant. You’ll need to visit Dr. Goosey the day after surgery, several times in the first two weeks, and then gradually longer intervals over the first year. With proper care, your transplant will last a lifetime.