In a cornea transplant, a graft replaces the central corneal tissue, damaged due to disease or eye injury, with healthy corneal tissue donated from a local eye bank. An unhealthy cornea affects your vision by scattering or distorting light, causing glare or blurred vision. A cornea transplant might be necessary to restore your functional vision.
Some of the events that might cause a cornea transplant are:
- Scarring from infections, such as eye herpes or fungal keratitis
- Eye diseases, such as keratoconus
- Hereditary factors
- Corneal failure from previous surgeries
- Thinning of the cornea and irregular shape, such as with keratoconus
- Complications from LASIK
- Chemical burns on the cornea or damage from an eye injury
- Swelling (edema) on the cornea
- Progressive deterioration of endothelial cell population, such as Fuchs’ dystrophy
Cornea transplants are performed routinely. In fact, of all tissue transplants, the most successful is a corneal transplant. More than 40,000 cornea transplants are performed in the United States each year, according to the Eye Bank Association of America 2008 statistical report.
To start the cornea transplant, the patient’s name is placed on a list at a local eye bank. The waiting period for a donor eye is generally one to two weeks due to a very sophisticated eye bank system in the United States.
Before donor corneas are released for transplant, the tissue is checked for clarity and quality and screened for presence of diseases, such as hepatitis, AIDS and other damage, to ensure the health and safety of the recipient. Typically, corneal transplants are performed on an outpatient basis and with local anesthesia.
A round, button-shaped section of tissue is then removed from your diseased or injured cornea. A button with a nearly identical shape from the donor tissue is then sutured into place. Finally, the surgeon places a plastic shield over your eye to protect it from being inadvertently rubbed or bumped. The surgery takes approximately one hour.
Most corneal transplants are successful. Nevertheless, recognizing the warning signs of problems is the best way to prevent corneal transplant rejection. The patients should familiarize themselves with the four main signs by remembering the acronym, RSVP: Redness, Extreme sensitivity to light, Decreased vision and Pain.
Recovering from a Cornea Transplant
The total recovery time for a corneal transplant can be up to a year or longer. Initially, vision will be blurry, and the site of the corneal transplant may be swollen and slightly thicker than the rest of the cornea. As vision improves, the patient will gradually be able to return to normal daily activities.
Stitches usually are removed three to 17 months post-surgery, depending on the health of the eye and the rate of healing. Adjustments can be made to the sutures surrounding the new cornea to help reduce the amount of astigmatism resulting from an irregular eye surface.
There is a new version of corneal transplant, known as Descemet’s Stripping Endothelial Keratoplasty (DSEK). In this new surgical method, only a very thin portion of the cornea is used for the transplant.
In 2009, the American Academy of Ophthalmology (AAO) endorsed DSEK as superior to the more conventional full-thickness corneal transplant procedure (penetrating keratoplasty) for better vision outcomes and stability, as well as fewer risk factors.
Since patients keep part of their cornea, the risk of rejection is much lower than with the regular procedure. Almost no sutures are required, so the recovery is much faster without inducing as much astigmatism and with better vision in a very short period of time.
The DSEK technique can be performed alone or in combination with cataract extraction and posterior chamber implant. Patients like those with Fuchs’ dystrophy benefit the most, since their vision is not usually severely depressed, and the fast recovery is very appealing when considering the risk/benefit ratios.
For more information on any of these procedures, visit our website at www.lasik2c.com.
