Corneal Transplants

Corneal tissue for transplant comes from an eye bank. The operation consists of transferring the clear central part of the cornea from the donor's eye to the patient's eye. Soon after the operation, the patient can resume activity.

Return of the best vision after corneal transplant surgery may take up to a year, depending on the rate of healing and the health of the rest of the eye. A contact lens may be required to obtain one's best vision after corneal transplant surgery. As in any transplant, rejection of the donated tissue can take place. The major signs of rejection are redness of the eye or worsening of vision. If these occur, a prompt return to an ophthalmologist is necessary, even if it is years after the original operation.

Advancements in cornea transplant technique over the last few decades have dramatically improved our ability to treat corneal disease with decreased complications, longer transplant survival, and improved visual outcomes.

Depending on your condition, your cornea surgeon may perform either a penetrating keratoplasty (PKP/full thickness), anterior lamellar keratoplasty (ALK/partial thickness anterior), or endothelial keratoplasty (DMEK or DSEK/partial thickness posterior). Each of these surgical techniques is tailored to your corneal disease. Your doctor will discuss with you their recommendation regarding corneal transplant surgery.

What to expect as you prepare for surgery:

Before Surgery

Eat a light meal and take your usual medications. On the same day as the surgery, please use whatever medical eye drops (for example, for glaucoma) you would normally use for the operative eye.

Pre-Op

The surgery is usually performed under conscious sedation with a local anesthetic of your eye. As directed by the physician, our Certified Registered Nurse Anesthetist (CRNA) may administer a sedative intravenously, and then after you are sedated, he/she will completely numb your eye. Patients rarely remember the numbing procedure, and once the eye is numb, they should not experience any discomfort during the surgical procedure. This also prevents you from seeing the surgery or moving the eye. The CRNA also gives you medicine by vein to keep you relaxed and a little sleepy during the surgery. Using local anesthesia avoids many risks to your heart or lungs that complete general anesthesia involves.

Surgery and Recovery

The length of surgery varies from 30 to 75 minutes, depending on the type of cornea transplant you are receiving. You may be asked to lay flat in the recovery room for up to 1 hour. The entire visit can take as long as 3-4 hours before you are ready to go home.

At-Home Instructions

We will advise you to lie flat on your back, facing the ceiling, as much as possible after the surgery for the first 24 hours. Anesthesia can cause some people nausea, so go slowly eating the evening you have surgery. You can go to the bathroom or sit up to eat meals as much as necessary in the first 24 hours after surgery, and it is not a danger to your transplant to do so, but whenever possible, try to rest in bed lying on your back and facing the ceiling. (one pillow is OK). This will allow the small air bubble inside the eye to best stabilize the transplanted tissue.

Activities

Most normal activities are permitted even on the first day after surgery. You can shower and wash your hair. Remember, however, that you are at risk for infection for the first two weeks after surgery, so avoid all activities that put you at risk for infection (like gardening, working in dirty environments, etc.). Use common sense, and you will be fine.

Finally, avoid any activities that may lead to taking a direct hit to the eye or pressure on the eye. No sports activities of any kind for 2 weeks after surgery. No swimming underwater for 4 weeks, but doing water exercises (always head out of water) is fine after two weeks.

Follow-up Visits

You will visit our office the day after surgery, where the patch will be removed and need not be re-applied. You will, however, be asked to wear a protective shield over the eye (without a patch) at night while sleeping for 1 week. No protection is needed during the day, but if you normally wear glasses for the other eye, go ahead and wear them. You will be placed on antibiotic and steroid drops to prevent infection and help with healing. You will have a brief visit to the clinic one week after surgery and then again at one and three months.

Vision Expectations

When the patch is removed, you will have poor vision for the first several days, which will allow you to only see well enough to count fingers from 2 feet away. Vision is poor because the donor tissue is still swollen. Additionally, it may take up to 1-2 weeks before the air bubble completely clears from the eye. Although the new cornea begins clearing your cornea almost immediately, it does so in patches.

By one week, most patients know their cornea is getting better, and their vision is clearing.

By one month, the vision is typically much improved, and patients feel that success is at hand. Gradual improvement typically continues over the next three months.

By one year, over 65%-95% of patients have 20/40 or better vision. Those patients with no other ocular problems (like macular degeneration or other retinal diseases) have the best vision of all after DSEK/DMEK surgery.

The vision continues to improve over time, with many patients improving their vision even from one to two to three years after surgery.

DMEK/DSEK Surgery

The ultimate vision after DMEK/DSEK surgery will depend more upon the health of the patient's retina and central vision of the macula than upon the clarity of the cornea, as nearly all DSEK patients attain a clear cornea with good surface focus after this surgery. A vision of 20/20 is possible, but even with a crystal-clear cornea, vision depends upon the function of the retina and may not attain 20/20. It is most important to remember that while the vision will be better than it was before surgery, vision improvement varies among all patients.

Generally, patients younger than 65 years old and those with vision better than 20/60 prior to surgery have the fastest visual recovery. Some of our patients have been 20/25 just one week after surgery, but these are the exceptions. Patience is still a virtue, even with DMEK/DSEK surgery.

Donor Tissue Dislocation

During your first post-op exam, the surgeon will examine your eye to ensure the donor tissue disc is properly positioned. If the donor disc is NOT in the proper position, then the disc must be re-positioned by the surgeon. The risk of this happening is between 2% and 10%. Nonetheless, this is a real risk of DSEK/DMEK surgery. Fortunately, a dislocated donor tissue can be successfully repositioned with good function and restoration of vision over 90% of the time. In the worst-case scenario, if the tissue cannot be successfully repositioned with a simple air bubble, we have the option of trying a new donor tissue or resorting to a conventional, full-thickness corneal transplant.

Penetrating Keratoplasty(PKP/Full-thickness) & Anterior Lamellar Keratoplasty ALK):

During your surgery, a “cookie-cutter” circular incision is made to remove the diseased central cornea. This is replaced by a clear donor transplant tissue, which is sutured into place, often requiring 16 sutures. Your surgeon may place a bandage contact lens over your eye to assist with comfort and healing after the procedure. The eye will be patched until you are seen for your post-operative appointment the following day. The surgery will take approximately 1 hour or longer.

Post-Op & Recovery

You will be in the recovery room for about an hour after the surgery, lying flat on your back, facing the ceiling. Prior to leaving, your surgeon will examine you to ensure that there is an appropriate size of air bubble and eye pressure.

The entire visit can take as long as 3–4 hours before you are ready to go home.

At-Home Instructions

Activities

Finally, avoid any activities that may lead to taking a direct hit to the eye or pressure on the eye. No sports activities of any kind for 2 months after surgery. No swimming underwater for 4 weeks. Your surgeon may ask you to avoid heavy lifting for up to 6 months.

Follow-up Visits

Vision Expectations

Visual outcome is variable depending on the cause/need for cornea transplant and whether your eye has any other abnormalities such as cataracts, glaucoma, or macular degeneration that may limit your vision.

Vision is typically blurry at first and gradually improves over the course of weeks to months. There is a likelihood of astigmatism affecting your vision that will ultimately require glasses or special contact lenses to optimize your vision. The sutures that are placed to secure the donor transplant contribute to astigmatism as well. These sutures typically remain in place until 6-12 months after surgery, after which your surgeon may remove them in the office. After all the sutures are removed and the eye is stable, a glasses prescription may be provided. Patience is required as full visual recovery from this procedure can take a year or longer!

FAQs/Frequently Asked Questions:

How long is the waitlist to get a cornea transplant?

Donor cornea tissue is generally readily available. Almost always, we can schedule your procedure and count on having a transplant for use. There are many “eye banks” around the country that collect, store, and distribute tissue every day. We appreciate organ donors who make this gift so accessible to those in need!

Do I need any blood-type matching to reduce the chance for rejection?

The wonderful thing about corneas is that there are naturally no blood cells/vessels within the tissue. It is “avascular”. This means that any donor (as long as they’ve met quality screening standards) can be used for any individual regardless of blood type or genetics.

Do I need to take anything by mouth for immunosuppression?

Fortunately, there is no need for systemic immunosuppression with cornea transplants. All you typically need are topical steroid eye drops to help prevent rejection.

RETURN TO CORNEAL DISEASES & DISORDERS

To schedule an appointment, call (509) 456-0107