Corneal transplantation or penetrating keratoplasty is a surgery to remove the diseased cornea and replace with a donor tissue. The surgery may be done with traditional surgical technologies or with the aid of a surgical laser. This procedure is considered a type of organ transplantation.
A corneal transplant may be necessary if you sustain a serious injury such as chemical burns to the corneas. Clouding or repeated scarring of the corneal tissues over time may eventually obscure vision until you need surgery. Extremely thin corneal tissue caused by keratoconus may require transplantation.
A cornea transplant can restore vision, reduce pain, and improve the appearance of a damaged or diseased cornea. Most cornea transplant procedures are successful.
Cornea transplant carries a small risk of complications, such as rejection of the donor cornea.
You will usually have to use antibiotic drops in your eye the day before your transplant to help prevent an infection. Most of the time, these surgeries are performed as outpatient procedures under local anesthesia. This means you'll be awake but woozy, the area is numb, and you'll be able to go home the same day. Your surgeon will use a microscope as he or she removes your injured cornea (with or without laser-assisted equipment) and replaces it with the healthy one, suturing it in place. Your doctor will do the entire surgery while looking through a microscope. It typically takes 30 minutes to an hour.
Please plan to stay in Thailand for at least two weeks to one month through the duration of your treatment. (This does not include a waiting period for the cornea.) It is recommended that you stay in a hotel close to the hospital for convenience in traveling to the hospital before and after the procedure. You will undergo a health screening when convenient for you before the procedure as the procedure is done using general anesthesia. You will likely need to fast before the health screening. You will be given detailed instructions by your medical team. Before your operation, your doctor will probably do an exam and some lab tests to check that you're in good general health. You may have to stop taking certain medicines, such as aspirin, a couple of weeks before the procedure.
Afterward, you'll probably wear an eye patch for at least a day, maybe 4, until the top layer of your cornea heals. Your eye will most likely be red and sensitive to light. It might hurt or feel sore for a few days, but some people don't feel any discomfort. Your doctor will prescribe eye drops to bring down inflammation and lower the chances of infection. They may prescribe other medicines to help with pain. They'll want to check your eye the day after surgery, several times during the following couple of weeks, and then a few more times during the first year. For transplant procedures such as DSEK and DMEK that use a gas bubble inside the eye to help position the transplanted tissue, the surgeon may ask you to lie flat sometimes during the day and sleep flat on your back at night for a few days. You'll have to protect your eye from injury after your surgery. Follow your doctor's instructions carefully.
During the surgery: Accidental injury on the innermost layer of the cornea, iris, intraocular lenses, vitreous hemorrhage may occur. The worst complication that may ariase is hemorrhage underneath the retina.
First phase after the surgery: Sutures leakage, flat anterior chamber, prolapse of the iris, sutures abscess, permanent defect cornea, ocular hypertension, and infection that is harmful to the vision.
Second phase after the surgery: Astigmatism, unhealed sutures, central serous chorioretinopathy (CSC), previous disease recurrence, and glaucoma.
Cloudy cornea: If cloudy cornea occurs the first day after the surgery, it is possible that the donor cornea is defected, or might be caused by the surgical injury. If it becomes cloudy later on, it is likely that the donor cornea is rejected as the body’s immune system tries to eliminate the foreign body. Graft rejection could possibly occur from week 2 to 1 year after the surgery.
Other symptoms include less vision, redness, irritation, tearing, and sensitivity to light. Corticosteroid is always recommended for treatment.
Emotional concern: Corneal transplantation is considered a major surgery of the eye. It might cause emotional concerns to the patient due to anxiety, stress, depression, anger, or disappointment. However, they are rare and the patient will undergo extensive evaluation by the physician both physically and emotionally before the surgery.
What is the success rate of a corneal transplantation?
The success rate is 70-95% (Le R, et al., 2017), depending on the patient’s condition and disease. The successfulness of the procedure depends on a number of factors including: -The patient’s cornea i.e. previous history, the cornea’s condition. -The patient himself i.e. the current illness, post-operative care. -Other complications such as glaucoma, retina disease, and uveitis. -An ophthalmologist specializing in cornea will assess your eye condition and provide the information on the success rates of the treatment after the assessment.
Where do donor corneas come from?
Regional facilities maintain tissue banks that include corneal tissue from individuals who have donated their corneas to medicine. The donor tissues are carefully inspected before surgery to make sure they are safe to use and appropriate for your eyes.
Will my vision change?
Vision usually is blurred after surgery. It gradually improves as healing takes place. As the eye heals and the sutures are removed, the shape of the cornea changes. Therefore, your surgeon usually will wait between 3 and 12 months before prescribing a new lens for your glasses. If needed, a contact lens may be prescribed.