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Corneal Transplant

(Keratoplasty; Penetrating Keratoplasty)

Definition

Corneal transplant is a surgical procedure used to replace a portion of a diseased or damaged cornea with a healthy one. The cornea is the clear, outer surface on the front of the eye.
Cornea of the Eye
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Reasons for Procedure

A corneal transplant can correct vision problems caused by infections, injuries, or medical conditions that effect the cornea. It is often recommended for the following:
  • Keratoconus—a thinning and bulging of the cornea that causes blurred vision
  • A cornea scarred from infection or injury
  • Clouding of the cornea
  • Complications of previous eye surgery

Possible Complications

The procedure is highly successful. Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • Rejection of the new cornea—The body’s defense system attacks the new tissue, damaging it.
  • Glaucoma
  • Problems focusing
  • Swelling or detachment of the retina
  • Cataract
  • Infection
  • Bleeding
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
The operation is most successful for those who have the following:
  • Keratoconus
  • Corneal scars
It is less successful for those who have corneal infection and severe injury, like a chemical burn.

What to Expect

Prior to Procedure

Your ophthalmologist may do a physical exam and blood tests.
Before the procedure:
  • Talk to your doctor about your medications. Also, discuss any herbs or vitamins you take. You may be asked to stop taking some medications up to one week before the procedure.
  • Arrange to have someone drive you home.
  • Arrange for help at home after the procedure.
  • Use any eye drops as instructed by your eye surgeon.
  • The day before, do not eat or drink anything after midnight unless told otherwise by your doctor.

Anesthesia

Two types of anesthesia can be used during a corneal transplant:

Description of Procedure

The procedure will be done under a surgical microscope. The damaged part of the cornea will be cut out. The new cornea will then be placed in the opening. The new cornea will be fastened with very fine stitches. Finally, a patch and shield will be put over the eye.
There is another technique called Descemet's stripping endothelial keratoplasty (DSEK). DSEK is used for some types of cornea transplants. It may result in shorter recovery time and better vision. With this technique, the doctor removes a much smaller part of the cornea, compared with older procedures.

How Long Will It Take?

1-2 hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

You will most likely go home after a few hours in the recovery area.

Post-procedure Care

At Home
Recovery at home includes pain management and avoiding certain activities until the eye heals. Other recovery steps may include:
  • Using eye drops
  • Wearing glasses during the day or a shield at night
  • Not rubbing the eye
  • Protecting the eye from accidental bumps or pokes
  • Avoiding contact sports
Vision may initially be worse than before your surgery before your eye adjusts to the new cornea. It may take several months for it to improve. Stitches are usually left in place for several months. Regular follow-up visits will allow the doctor to monitor how the eye is healing.

Call Your Doctor

It is important to monitor your recovery. Alert your doctor to any problems. If any of the following occur, call your doctor:
  • Signs of infection, including fever and chills
  • Vision symptoms, including decreased vision, floaters, flashing lights, increased light sensitivity, or loss of peripheral vision
  • Increased eye redness
  • Increased pain
  • Persistent nausea or vomiting
If you think you have an emergency, call for medical help right away.

RESOURCES

Eye Bank Association of America http://www.restoresight.org

The National Keratoconus Foundation http://www.nkcf.org

CANADIAN RESOURCES

The Canadian National Institute for the Blind http://www.cnib.ca

Canadian Ophthalmological Society http://www.eyesite.ca

References

Corneal and external transplants. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/services/cole-eye/treatments-services/cornea-external-disease. Accessed June 27, 2013.

Corneal surgery FAQ. The University of Mississippi Medical Center Department of Ophthalmology Services website. Available at: http://www.umc.edu/education/schools/medicine/clinical%5Fscience/ophthalmology/clinical%5Fservices(ophthalmology)/corneal%5Fsurgery%5Ffaq.aspx. Accessed June 27, 2013.

Corneal transplants. National Keratoconus Foundation website. Available at: http://www.nkcf.org/corneal-transplants. Accessed June 27, 2013.

Facts about the cornea and corneal disease. The National Eye Institute at the National Institutes of Health website. Available at: http://www.nei.nih.gov/health/cornealdisease/index.asp. Updated May 2013. Accessed June 27, 2013.

Frequently asked questions. Eye Bank Association of America website. Available at: http://www.restoresight.org/about-us/frequently-asked-questions. Accessed June 27, 2013.

New advance in cornea transplantation. Duke Health website. Available at: http://eyecenter.dukemedicine.org/eye%5Fcenter/health%5Flibrary/news/new%5Fadvance%5Fin%5Fcornea%5Ftransplantation. Updated July 10, 2009. Accessed June 27, 2013.

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