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Corneal Transplant

Corneal Transplant

What is a corneal transplant?

Corneal transplant procedures may restore vision to otherwise blind eyes in some cases. In this procedure the damaged corneal tissue in an individual eye is replaced by the healthy corneal tissue of donor.

Who can benefit from corneal transplant?

There are many conditions in which corneal transplantation may be considered. The most frequent indication is pseudophakic bullous keratopathy, which is a corneal decompensation that occasionally follows cataract surgery. Pseudophakic bullous keratopathy may account for about 17% of all corneal transplant procedures. Less frequent indications include corneal ulceration, corneal scars, keratoconus, herpes simplex and Varicella zoster viral infections leading to scarring, Fuch’s endothelial dystrophy, congenital opacities of the cornea, and chemical burns of the eye.

How is the procedure performed?

A complete pre-operative evaluation will be required prior to surgery. The surgeon will make every attempt to confirm retinal and optic nerve function prior to surgery, so as to avoid cases in which visual improvement is unlikely.

The majority of adult patients may be operated on under local anesthesia. General anesthesia will likely be required for children, anxious, or uncooperative patients. After the anesthetic is given, the surgeon usually sews a ring to the ocular surface to support the eye. The donor cornea is prepared using a punch or corneal trephine to create the corneal “button.” The corneal button will become the transplanted cornea. The diseased, or scarred, cornea is then removed using a corneal trephine, creating a “bed” for the transplant cornea. Finally, the donor cornea is gently sewn into place with ultra-fine sutures (approx. one-third the thickness of human hair, or less). Corneal transplantation may be combined with other procedures, particularly cataract extraction with intraocular lens implantation.

How are the results of corneal transplantation?

Postoperatively, patients should expect very gradual recovery of vision. In fact, the best vision may not be obtained for six to 12 months or more following surgery, even though vision may be improved from the first day after surgery in some cases. The surgeon will likely begin to remove some sutures from the cornea within a few weeks to a few months after surgery. However, all of the sutures need not be removed. In general, sutures are removed to help alleviate astigmatism once the cornea begins to show signs of being securely healed into place.

What does post op care involve?

In individuals undergoing corneal transplant the follow up is prolonged. Your doctor will be seeing you regularly for the next two months after surgery. During this time you will be expected to apply topical steroids and Mydiatic eye drops. Topical steroids should be continued QD for 6 months, the QOD for another 6 months. Apart from these you will also have to apply topical antibiotics and sometimes topical antiglaucoma medications.

Your doctor may remove some sutures during the later half of the post op period. One will have to maintain high levels of hygiene during the post op period.

What are the complications of the procedure?

Early complications include flat anterior chamber, persistent epithelial defects, and infection.

Late complications include glaucoma, astigmatism, late wound seperation, cystoid macular edema, and recurrence of the initial disease in the donor graft.

Graft failure – graft failure is when the graft instead of remaining clear and transparent starts to turn white. It can be of early and late types.

Early: Cloudiness of the cornea from the first post-op day. It is usually caused by defective donor endothelium or trauma during surgery.

Late: Usually the result of immune graft rejection. 50 % occur in the first 6 months, and the majority occur in the first year post-op.

Treatment of graft rejection is by hourly topical steroids, as well as periocular steroid injection, as well oral steroid depending on the clinical picture.