What is corneal transplant surgery?
Cornea is a transparent tissue on the surface of the eye. A diseased or damaged cornea may need to be replaced to restore vision. In most cases, a corneal tissue from a donor is grafted to replace the previous cornea. The procedure is called a corneal transplant or keratoplasty.
A keratoplasty (surgery to the cornea) can be performed on the entire cornea or merely on a part of it. Corneal transplant techniques and options differ depending on the degree of the injury and the preference of the surgeon. More on that, further on this article.
Corneal transplant surgery usually takes between 1 to 2 hours. The procedure starts with putting the patient under local or general anesthesia. Along with local anesthesia, a sedative might also be administrated to help the patient relax. Then using the donor corneal tissue (or artificial cornea), the surgeon replaces the cornea. The healthy cornea is placed in the opening and is fixed in place using fine stitches that may or may not be removed later.
Donor
A cornea transplant patient can receive corneal tissue from any eligible donor regardless of age, race, and blood type compatibility. An eligible eye donor must go under screen tests to be checked for signs of diseases such as HIV, Hepatitis, and Syphilis. In other words, most people can be a universal cornea donor as long as there are no infections affecting the cornea.
As soon as an organ donor is deceased, the window of opportunity to acquire the cornea would be 24 hours. After procuring the cornea, the tissue can be stored in an eye bank and be used within 14 days of time.
Corneal transplantation surgery options
Corneal transplantation can be performed using several techniques. It is up to the surgeon to decide which option to go for depending on the severity of your condition. Most cornea transplant surgeries involve replacing the entire cornea; this technique is known as penetrating corneal transplantation or full thickness corneal transplant. In other cases, a particular part of the cornea may need to be replaced.
Full-thickness corneal transplant
If your cornea is damaged in both front and inner layers, you may need a full thickness corneal transplant. Also known as penetrating keratoplasty, this method is a very common option involving removing damaged or scarred cornea and placing a healthy and clear donor cornea. More specifically, the surgeon either uses an instrument called a trephine or a femtosecond laser to cut into the thickness of the abnormal cornea. After removing a small button-sized disk of tissue, he or she will place a "button" of normal corneal tissue on the area.
The recovery period after penetrating keratoplasty is longer than other options. It might take a year before your vision is completely back. Besides, a PK is slightly more likely to be followed by cornea rejection after the surgery.
Partial thickness corneal transplant
Partial thickness or lamellar keratoplasty is effective when only the front and middle layers of the cornea need to be replaced. Partial thickness corneal transplant leaves the endothelial or back layer intact. This technique is particularly beneficial for abnormalities such as keratoconus.
With a partial corneal transplant, the recovery time is shorter and there are fewer chances of cornea rejection.
Endothelial keratoplasty
Endothelial keratoplasty can be described as s partial transplant. It entails replacing a certain innermost layer of the cornea named endothelium. Damaged endothelium can lead to swelling and might affect the vision. Endothelial keratoplasty has two types; DSEK and DMEK. Both types remove damaged cells and place new tissue in their place. They are different in terms of thickness of the donated cornea. With DMEK, the donor tissue is thinner leading to a more difficult transplant but faster recovery period.
Success and rejection rate
Cornea transplant has a significantly high success rate. Modern eye banking systems and developed surgical techniques have provided up to 90% chance of a clear corneal graft. In addition, with modern techniques and enhanced eye bank systems, the rejection rate is less than ever; particularly in Iran where surgeons and clinics are thriving to deliver the best results. You can make sure a qualified medical team will monitor your transplant for signs of rejection.
Eye transplant in Iran
All around the world, people have to stay on waiting lists and pay large sums of money to get a cornea transplant. The average cost of cornea transplant surgery can vary from $13,000 to $27,000. Thus, many patients are tempted to undergo surgery abroad. Iran, for example, offers high-quality and world-class treatments at a fraction of the cost charged in US or Australia.
Cornea transplant surgery recovery and aftercare
The recovery after a cornea transplant may take up to 6 to 12 weeks. Immediately after the surgery, you might have to spend approximately a week in the hospital. The surgeon might also advise you to wear a plastic shield to protect your eye during healing.
After most types of corneal transplant surgery, you should lie on your back looking at the ceiling for about 48 hours. You can only get up for eating or using the washroom. You might be recommended to continue using eye shields at nights while sleeping.
It is also important not to rub your eyes; no matter how irritated or scratchy they get. Another temporary side effect of a cornea transplant is getting blurry vision after the surgery.
Your surgeon might prescribe many medications including eye drops. It is essential that you follow instructions and administrate the eye drops exactly as directed by your doctor.
You should wait about 4 weeks before you can do strenuous activities or lift heavy things.
Risks and side effects
As mentioned above, corneal transplants are generally successful with almost no risks or complications. The most common risk after corneal transplantation is cornea rejection, But It can be easily treated by medications.
A corneal transplant surgery might also be followed by some surgical side effects that are noticeably rare but possible:
- Bleeding
- Infection
- Broken sutures
- Reactions to anesthesia
- Alterations in the eye pressure
- Eye fluid leaking out
- Retinal Detachment
- Swelling
- Cataracts
FAQ
Does corneal transplant improve vision?
Your vision will gradually improve within a few weeks after the surgery. In some cases, you might end up with a degree of nearsightedness or astigmatism that can be helped by LASIK eye surgery.
Can a corneal transplant cure glaucoma or blindness?
People with glaucoma can undergo corneal transplant; although it can increase the rejection rate. After the surgery, Additional glaucoma treatment might need to be performed.
Is corneal transplant painful?
Corneal transplant is performed while the patient is under local or general anesthesia. As a result, you won't feel any discomfort during the surgery. Some mild pain is normal after the surgery and can be controlled using OTC pain-killers.
