A cornea is the transparent layer forming the front part of the eye. Corneal transplant (also known as keratoplasty) is a surgical procedure where a damaged cornea is replaced with a healthy donor cornea. Hospitals maintain eye banks where they store corneas from donors who are deceased which can be used for up to 14 days. This procedure is mainly done to restore vision of a patient with a damaged cornea.
WHEN A CORNEAL TRANSPLANT IS ADVISED
Corneal Transplant is done only when damage to the cornea is too severe and can’t be treated with corrective lenses or medical management. Occasionally, corneal transplant is combined with other eye surgery such as cataract surgery to solve multiple eye disorders within one procedure.
WHAT CAUSES DAMAGE TO CORNEA:
Cornea can be damaged regardless of age. Sometimes due to disease, injury or infection. A damaged cornea disturbs the path of light entering into the eye which in turn leads to distortion in vision and may also be a painful condition.
PREPARING FOR THE SURGERY
ON THE DAY OF SURGERY
In most cases, these surgeries are done as outpatient procedures and rarely needs hospitalisation. Patient will most likely be conscious/awake during the transplant procedure. Local anaesthesia will be injected around the eye to block pain and control eye movement during the surgery. Also relaxing medications will be administered. Surgery usually takes 30 minutes to an hour to complete.
Patient can go home on the same day of surgery and will be provided with an eye patch to wear for about 1 to 4 days to prevent injury to new cornea. Initially post- surgery, eye may feel scratchy and irritated. Vision will be somewhat blurry for several months. The first stage of healing will take about 3-4 weeks. After this phase, patient will need to use contact lenses or glasses. These may need to be changed or adjusted several times in the first year after the transplant. Eye drops will be prescribed to help healing and prevent infection and rejection along with pain-relieving medicines. Stitches will be removed at a follow-up visit.
Full recovery of eyesight may take up to a year. Most people who have a successful corneal transplant will have good vision for many years. The donated tissue usually lasts a lifetime. If any underlying medical condition exists, there’s still chances of vision loss. Laser vision correction may be an option for nearsightedness, farsightedness, or astigmatism after transplant has fully healed.
KNOW YOUR RISKS
A corneal transplant is considered a fairly safe procedure, but there can be risks and possible complications. In about 1 out of 5 transplants, the body’s immune system attacks the donated tissue. This is called Rejection. Sometimes it can be treated with medical management, but in few cases patient may need another transplant. Nowadays, DSEK and especially DMEK procedures are most common as very little donor tissue is used there’s a much lower risk of rejection with these procedures.
Patient should be careful post-surgery and immediately visit emergency if any signs and symptoms of rejection is experienced, like:
Other risks may include: Infection, bleeding, higher pressure in the eye (called glaucoma), clouding of the eye’s lens (called cataracts), swelling of the cornea, a detached retina (when the back inside surface of the eye pulls away from its normal position).
There are several issues of the eye which can be restored using corneal transplant:
Unlike in other organ donations, age and blood type are not really important for determining cornea donor suitability.
Before cornea transplant surgery, the patient will undergo the following tests:
During the cornea transplant (penetrating keratoplasty), the surgeon cuts through the entire thickness of the damaged cornea to remove a small button-sized disk of corneal tissue. An instrument is called trephine is used to make this precise circular cut. The donor cornea cut precisely to fit is placed in the opening. The surgeon then uses special surgical thread to stitch the new cornea into place. The stitches are removed at a later consultation visit.
Post surgery the patient will have to stay in the hospital overnight for observation. They will to wear an eye patch or plastic sheath for 3-4 days post discharge. He or she will be advised be extra careful with the eye for the next 2-3 months to ensure proper healing. There will be some discomfort and blurred vision the first few days which is completely normal.
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Q: What is the success rate of Corneal Transplant surgery?
A: In normal conditions where patient don’t have any co-existing medical condition, success rate of Corneal transplant may be as high as 90% with clear vision by use of glasses/contact lenses.
Q: How can I get a donor and what is the viability of graft?
A: Mostly corneal tissues (graft) are taken from a deceased donor and eye-bank keeps a reserve of corneal tissues in its laboratory. Cornea tissues can be stored for up to 14 days before transplantation.
Q: What are the chances of graft rejection?
A: Since cornea doesn’t have blood-supply; chances of rejection is very less. In only 10% cases rejection occurs for which another transplant is performed with different tissues.
Q: Can Corneal Transplant treat blindness?
A: In blindness where optic nerve (which goes directly to nerve) is damaged cannot be treated by corneal transplant. Corneal transplant can only treat blindness or vision loss due to corneal tissue damage.
Q: Can u see clearly after corneal transplant?
A: Eyesight would gradually improve a few weeks after a corneal transplant, but it could take anywhere from a couple of months up to a year to have restored clear vision in the eye.
Q: Will my vision will be restored fully if I also have astigmatism after corneal transplant?
A: In cases where there is existence of other medical condition of eye such as Astigmatism, myopia or hypermetropia, laser treatment may be required after the transplant has been completely healed. This helps in restoring clear vision.
Q: Can damage to cornea be treated without transplant?
A: If the damage is not so severe and not very painful or distorting clear vision it may be managed by use of glasses, but eventually there will be thinning of cornea and there may be a need to undergo corneal transplant.
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