Corneal transplant surgery or Keratoplasty, is a surgical process that involves the replacement of pathological or damaged cornea tissue with donor corneal tissue. The cornea plays an important role in focusing the vision and seeing clearly, it is a transparent, dome-shaped surface of the eye. When the corneal surface becomes cloudy (opaque) or scarred it can result in severe vision impairment.

A corneal transplant is a vision correction surgery, done to restore the vision of the person, with a damaged or distorted cornea. Corneal transplant surgery can reduce pain and other symptoms related to corneal damage or disorder.

This blog highlights the corneal transplant procedure, its types, risks and complications, and post-operative care.

What are the Indications for Corneal Transplant Surgery?

If someone has the following conditions, an eye specialist may suggest a cornea transplant:
Cornea damage caused by earlier eye injury or surgery.

• Swelling, infection, and injuries of the cornea (Bullous Keratopathy)
• Tearing or thinning of cornea
• Corneal ulcers
• Keratoconus treatment (a condition in which the cornea shape becomes like a cone rather than a dome shape).
• Fuchs’ dystrophy (a condition in which endothelium cells of the cornea die off, which results in corneal swelling with fluid).
• Corneal Dystrophies: Genetic conditions affecting the clarity of the cornea.

Types of Corneal Transplant Surgery

The types of corneal transplant surgeries are based on the results regarding the pathology of the cornea. There are different types of corneal transplant surgeries, each matched to the specific condition of the cornea:

Penetrating Keratoplasty (PK): This full-thickness corneal transplant replaces the entire cornea.
This type is typically used for conditions that affect all layers of the cornea, such as advanced keratoconus, serious corneal scarring, and some forms of corneal dystrophies.

Endothelial Keratoplasty (EK)
This type involves the replacement of just the innermost layer of the cornea, that is, the endothelium.
It is further divided into Descemet’s Stripping Endothelial Keratoplasty and Descemet’s Membrane Endothelial Keratoplasty.

It is used for conditions like bullous keratopathy and Fuchs’ endothelial dystrophy.

Anterior Lamellar Keratoplasty
This type of surgery replaces only the front or anterior layers of the cornea and the healthy endothelium layer is left intact.
It has two types: Superficial Anterior Lamellar Keratoplasty and Deep Anterior Lamellar Keratoplasty.
It is used for anterior corneal diseases like superficial scars and keratoconus without endothelial involvement.

The Surgical Process of Corneal Transplant Eye Surgery

1. Pre-Operative Preparation

• Evaluation: Detailed eye examination is carried out and includes measurement of the eye, checking the overall health of the eye.
• Donor Matching: The donor cornea is matched for size and compatibility.
• Informed Consent: The patient is informed about the procedure, risks, and post-operative care.

2. The Procedure:
• Anesthesia: The surgery is almost always done under local anesthesia with sedation, but general anesthesia can be employed in some cases.
• Incision: A definite circular incision is made in the damaged cornea.
• Donor Tissue: The donor cornea is prepared and carefully placed.
• Suturing: Fine sutures are placed to hold or secure the donor cornea in place.

3. Corneal Transplant Recovery and Post-Operative Care:
• Medications: Antibiotics along with steroid eye drops are prescribed to the patients to prevent infection and reduce inflammation.
• Follow-up Visits: Regular follow-up visits after discharge are essential to assess healing and to identify and treat any developing complications.
• Activity Restrictions: Patients should not engage in any strenuous activities, heavy lifting, or swimming for several weeks.

Corneal Transplant Risks and Complications

While corneal transplant surgery is generally considered relatively safe, risks may include the following:

• Rejection: The immune system may recognize that the donated cornea is ‘foreign’ and attempt to reject it.
• Infection: While uncommon, infection is still a possibility after surgical intervention, just like with any other surgical operation.
• Astigmatism: Irregular curvature in the cornea might occur that would need corrective lenses later on.
• Graft Failure: The transplanted cornea can occasionally not even turn out to be functional; these cases may require further surgery.

Success Rates and Outcomes

The success rate of corneal transplants depends on the type of surgery and underlying condition. Most of the patients will usually show considerable improvement in vision. For instance, endothelial keratoplasty surgery has a very high success rate compared to penetrating keratoplasty and has less recovery time. The average cost of corneal transplant surgery is approx. 40,000 to 60,000 per eye. Enhanced surgical techniques and post-operative care across the board ensure that patients going for corneal transplant operations get to enjoy ever-improving outcomes.

For instance, endothelial keratoplasty represents a high success rate and has a quicker time to recover compared to penetrating keratoplasty. The continuing enhancement of the surgical techniques together with the post-operative care, continues to bring out a better result among patients who undergo corneal transplant procedures.

Conclusion

Corneal transplant surgery will change life generally in cases of corneal diseases and injuries. The different types of transplants, details of the surgical procedure, and post-operative care should be known to the patients and their families. The future of corneal transplantation is bright, with continuous improvement in medical technology and surgical techniques.

If someone is considering having a corneal transplant, seek an appointment with an experienced ophthalmologist to discuss the best options in your case.

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Written and Verified by:

DR. AJOY SINGH VIRDI

MBBS, DNB (OPHTHALMOLOGY)

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