A corneal transplant (also known as a corneal graft or keratoplasty) involves the removal of the central portion (called a button) of a diseased cornea and replacing it with a matched donor button of cornea. The cornea is the clear part of eye in front of the iris and pupil. This procedure is performed on patients whose vision is impaired due to damaged or scarred corneas as a result of disease or trauma. This surgery is procedure is performed by ophthalmologists (medical doctors who specialize in eyes) and are often done on an outpatient basis.
Please check here for price estimates. Price changes and updates are not shown on the website immediately. If you wish to obtain more information regarding the current costs of a particular procedure, please contact us .
A number of factors must be considered in deciding when to do a keratoplasty; it usually isn’t an easy decision to make. One of the most important aspects that most be taken into consideration is the patient’s functional vision. If the best acuity with their contact lenses prevents them from doing their job or carrying out their normal activities, a transplant must be considered.
A corneal transplant can be performed as a solution to the following conditions:
- Optical problems: this surgery can be performed to improve visual acuity by replacing the opaque host tissue by clear healthy donor tissue. The most common conditions in this group are pseudophakic bullous keratopathy, followed by keratoconus, corneal degeneration, keratoglobus and dystrophy, as well as scarring due to keratitis and trauma.
- Tectonic/reconstructive reasons: keratoplasty can be performed to preserve corneal anatomy and integrity in patients with stromal thinning and descemetoceles. It can also reconstruct the anatomy of the eye; for example, after corneal perforation.
- Therapeutic reasons: this procedure can be undertaken to remove inflamed corneal tissue unresponsive to antibiotic or antiviral treatment.
- Cosmetic reason: keratoplasty can be performed to improve the appearance of patients with corneal scars that have given a whitish or opaque hue to the cornea.
You will be given a brief physical examination by the surgical team before going into surgery. In the operating room, you will lie down on the table and will be given general or local anaesthesia, depending on your preferences.
After this, your HCR surgeon will prepare the eyes for the procedure; your eyelids are carefully washed and covered with a sterile plastic drape. An eyelid speculum is placed to keep the lids open and some lubrication will be to prevent the eye from drying. A metal ring is then stitched to the sclera, which will provide a base for a trephine (a circular cookie cutter-like instrument).
The entire procedure is done under a microscope. A trephine is then placed over the cornea and is used by the surgeon to cut the host cornea. The trephine is then removed and the surgeon cuts a “button” (circular graft) from the donor cornea.
Once this is done, the surgeon returns to the patient’s eye and removes the host cornea.
The donor cornea is then brought into the surgical field and maneuvered into place with forceps.Once it is fitted, the surgeon will attach the cornea to the eye with a running stitch or multiple interrupted stitches. The surgeon finishes up by restructuring the anterior chamber with a sterile solution injected by a cannula. Afterwards, it is tested to see if it’s watertight by placing a dye on the wound exterior.
With the metal ring removed and antibiotic eye drops placed, the eye is patched, and you will be taken to a recovery area while the effects of the anaesthesia wear off. The patient typically goes home following this and sees the doctor the following day for the first post operative appointment.
Post-Op -After Surgery
After a keratoplasty, patients should expect a very gradual recovery of vision. You should keep in mind that the recovery process following transplant is long and it can often take a year or longer.
Right after the procedure, you should rest the remainder of the day. Post-surgical pain varies from patient to patient. Usually, there is either no pain or only slight soreness for a few days; this can be relieved by prescribed painkillers from your physician.
The operated eye is patched until the top layer of the cornea is heals; they usually takes from 1 to 4 days. Do not remove the patch. Your doctor will see you the day after surgery and will remove the patch to determine if it needs to be worn longer. You will also receive detailed instructions during this visit. You must make sure you really understand the instructions and do not hesitate to ask questions if something is unclear.
Eye drops will be extremely important and you must be sure you know exactly when you should use them. Make your next appointment, usually in three to seven days. Be sure you know how to contact the doctor if there is a problem or you have questions.
After the patch is removed, it is important to protect the eye from accidental bumps or pokes. Usually, for several months after surgery, patients wear glasses during the day and a metal or plastic shield at night to protect the eye from trauma while sleeping. Since the new cornea is delicately sutured in place, a direct blow to the eye must be avoided at all costs. Contact sports are greatly discouraged after a keratoplasty. Otherwise, normal activity can be resumed within a few days. After the first day, shaving, brushing teeth, bathing, light housework, bending over, walking, reading and watching TV will not hurt the eye.
The time from surgery to the removal of the stitches is commonly 6 to 17 months. As a matter of fact, the best vision may not be obtained for 6 to 12 months or more following surgery, even though vision may be improved from the first day after surgery in some cases. Your doctor will likely begin to remove some sutures from the cornea within a few weeks to a few months after surgery; it all depends on your case in particular. However, all of the sutures need not be removed. In general, sutures are removed to help alleviate astigmatism once the cornea begins to show signs of being securely healed into place.
If a contact lens is required following keratoplasty it is customary to wait at least 3 months after the surgery and preferably until after the sutures are removed, which may be up to a year, before fitting contact lenses.
Even though the cornea doesn’t have any blood vessels, there is still a potential for some blood loss, usually from suturing the metal ring to the sclera. However, any blood loss is typically less than a teaspoon (less than 2 cc).
There is also a risk of infection. Since the cornea is avascular (it takes its nutrients from the aqueous humor) it heals much slower than a cut on the skin. While the wound is healing, it is possible that it might become infected by bacteria. This risk is minimized by applying antibiotic (using antibiotic eye drops, even when no infection exists).
Rejection is a major complication, which can affect any transplant. It happens when your body detects that a piece of tissue from another person has been put into you, and your immune system then tries to destroy it. About one in seven patients who have a corneal graft will have a rejection attack at some stage, although some patients are at a much greater risk than others. Rejection can start as soon as two weeks after the surgery but is most common several months afterwards and may occur years later.The quicker rejection is diagnosed, the better the chance of recovery. If your eye gets red, watery or gritty, and develops cloudiness of the vision, then rejection may be the cause and you are advised to contact your doctor immediately. If rejection is found, it is treated with very frequent, strong steroid drops and occasionally with steroid tablets or drip feeds. Most corneal grafts do recover from their rejection attack but a lot of patients will need to go on with the steroid drops for a long time afterwards, sometimes permanently.
Sure to ask your surgeon concerning any risks you might have to face when undertaking this surgery. However, you must keep in mind that our certified group of doctors works full-time to prevent such scenarios from happening, since we value the health of our patients above anything else.