Corneal Transplant
The usual reason for performing a transplant is to help you to see better. For some people, however, the operation may be advised to help in the treatment of chronic pain and irritation in the eye. In that case, the operation may be worthwhile even if it does not greatly improve your vision.What is Corneal Transplant?
The cornea is the tissue on the very front of the eye covering the iris and pupil. This surgical procedure involves the removal of the damage tissue and replacement with a healthy human cornea. It works with the lens to provide focusing power to the eye.
What conditions may require corneal transplants?
- Rejection after first corneal transplant
- Hereditary corneal failure
- Corneal failure after other eye surgery, such as cataract surgery;
- Keratoconus
- Scarring after infections or injury
- Complications from LASIK
The procedure usually takes between 1 and 2 hours.
How much pain is there?
The surgery is painless due to the administration of a local anesthetic at the beginning. However, some patients may be given general anesthesia, depending on their medical condition. Some pain medicine could be given after surgery to control any residual pain present during the recovery period.
What can I expect after the procedure?
After the procedure it is important to use the eye drops as prescribed, to not rub or press on the eye, to use over-the-counter pain medication, reduce exercise until healed or according to your doctor advisement, use the eye shields and patches as direct by your doctor, and not to drive until given approval.
You will need someone to drive you home. If the procedure is performed under local anesthesia, you can go home after a short stay at the center. The use of general anesthesia will delay your leaving by about two additional hours; to be sure the effects are wearing off.
What can I expect after transplant surgery?
When you leave the hospital you will wear a patch and a shield. This will be removed the next day at your follow up visit at the doctor's office. After that you will be wearing dark glasses during the day and a protective shield at night only. Your vision will be blurry for approximately 3 - 6 months.
At 3 months you will start having your sutures removed and they should all be removed by the end of 6 months a little longer if you are older. At the end of 6 months you will be fitted with glasses or contact lenses. During the whole 6-month period you will take anti -rejection drops and antibiotic drops approximately 4 times a day.
For the first 6 weeks heavy exercise and lifting of heavy objects will be prohibited but otherwise you can live a normal life. Most people return to work 3-7 days after their surgery depending on the type of work they do.
An extremely important part of the recovery period is constant vigilance as to signs of rejection. Rejection occurs in 5-30% of all transplants and there is an increased risk if this operation is a second transplant after rejection of an initial one. If the rejection is noticed early, medication can be administered that will halt the reaction and save the transplant.
Rejection occurs because the body's immune system recognizes the donor tissue as foreign and mounts a response against it. This damages the tissue such that it can no longer maintain the fluid balance, causing it to swell and lose clarity. Although the tissue will not fall out of the eye upon rejection, another transplant may be necessary to replace the tissue if too much damage occurs.
There are four signs of rejection that can be remembered by the mnemonic RSVP: redness, sensitivity to light, decreased vision, or pain. Any of these four symptoms, experienced after the initial healing period, should be reported to your ophthalmologist immediately.
Lamellar Corneal Transplant
Lamellar Corneal transplant (video link)
This surgery involves only a partial thickness of the cornea that is transplanted to replace only the diseased porting leaving the rest of the healthy cornea. It is then replaced with a portion of a cornea from a donor eye. It is a finer surgical procedure with more refined instrumentation. In this procedure, the cornea is removed to the depth of posterior stroma and the donor button is sutured in place. The two types of Lamellar Keratoplasty are: Deep anterior LK is used in eyes where the pathology is confined to the anterior (front) layers of the cornea; and Deep Lamellar Endotelial Keratoplasty that is used to replace the innermost layer of the cornea, called the endothelium, which is responsible for maintaining the transparency of the cornea.
NEW Laser-assisted Lamellar Keratoplasty (corneal transplant)
This is a new laser-surgery technique to perform cornea transplants. With the new Laser-assisted Lamellar corneal transplant, laser is used to create a precise corneal incision resulting in a perfect match of the donor and the patient. In addition to the precision the laser can create complex shapes that are impossible to achieve with conventional surgery. Furthermore, with this technique, recovery time is faster, less suture required, rejection risk is low and the strength of the repaired area of the cornea may be nearly 10 times that of conventional transplants.
