Corneal Transplant
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Corneal Transplant

(Keratoplasty; Penetrating Keratoplasty)

En Español (Spanish Version)

Definition

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. The surgery is performed by an ophthalmologist, a doctor who specializes in treating eye problems.

Cornea of the Eye

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Parts of the Body Involved

Eyes

Reasons for Procedure

A corneal transplant can correct vision problems caused by infections, injuries, or medical conditions. It is often recommended for the following:

  • Keratoconus—a thinning of the cornea that causes blurred vision
  • A cornea scarred from infection or injury
  • Clouding of the cornea
  • Pseudophakic bullous keratopathy—clouding and swelling of the cornea after cataract surgery (rare with modern cataract surgery techniques)

Risk Factors for Complications During the Procedure

The procedure is highly successful. Severe complications are rare. People in good physical health have the lowest risk for complications.

Complications that may occur during the procedure include the following:

  • Reactions to anesthesia
  • Bleeding, in rare cases
  • Leaking of the wound
  • Damage to the contents inside the eye

What to Expect

Prior to Procedure

Your ophthalmologist will likely do the following:

  • Physical exam
  • Routine laboratory tests, such as EKG (electrocardiogram) to monitor your heart
  • Blood tests

In the days leading up to your procedure:

  • Review your regular medications with your ophthalmologist; you may be asked to stop taking some drugs. Also discuss any herbs or vitamins you take.
  • Arrange to have someone drive you home.
  • Arrange for help at home after returning from the hospital.
  • Use any eyedrops as instructed by your ophthalmologist.

The day before your procedure:

  • Do not eat or drink anything after midnight unless told otherwise by your ophthalmologist.

The day of your procedure:

  • You will be given eye drops and medication to help you relax.
  • A needle attached to a tube will be inserted into a vein to deliver medicine and fluids (IV).
  • Heart monitor leads will be attached to your chest.

Anesthesia

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

  • Local anesthesia (most commonly used)—An injection is given to numb the eye; you stay awake during surgery.
  • General anesthesia—Medication is given to put you to sleep during the operation.

Description of the Procedure

The procedure is performed under a surgical microscope. A trephine, an instrument that looks like a tiny, round cookie cutter, is used to cut out the damaged part of the cornea. The new cornea is then placed in the opening and fastened with very fine stitches. Finally, a patch and shield are put over the eye.

After Procedure

You will stay in the recovery room until you are fully awake. After you leave the hospital, you should rest for the remainder of the day.

How Long Will It Take?

The surgery usually takes 1-2 hours.

Will It Hurt?

  • Anesthesia prevents pain during surgery.
  • You may experience slight soreness for a few days after surgery; ask your doctor about medications to help with the pain.

Possible Complications

  • Rejection of the new cornea—the body’s defense system attacks the new tissue, damaging it
  • Glaucoma—a vision-impairing disease caused by increased pressure inside the eye
  • Problems with focusing
  • Swelling or detachment of the retina—the part of the eye that sends light and images to the brain via the optic nerve (detachment occurs when the retina is lifted or pulled from its normal position)
  • Infection
  • Bleeding

Most of those complications can be treated. Tell your ophthalmologist about any problems immediately, and attend all follow-up appointments.

Average Hospital Stay

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

Postoperative Care

When you return home after the procedure, do the following to help ensure a smooth recovery:

  • Wear your eye patch until it is removed by your doctor (unless instructed otherwise).
  • Use eye drops as prescribed.
  • Wear glasses during the day and a shield to protect your eye at night.
  • Protect your eye from accidental bumps or pokes.
  • Do not rub or press on your eye.
  • Do not swim until allowed by your doctor.
  • Avoid contact sports.
  • Do not drive until your doctor says you can.

Your eye will be checked the day after surgery and several more times during the following weeks and months. Stitches are usually left in place for at least several months.

Outcome

Most people who undergo a corneal transplant enjoy improved vision for many years, or even a lifetime. It can take up to a year for vision to stabilize after surgery; however, most people still need to wear glasses or contacts.

The operation is most successful for patients who have the following:

  • Keratoconus
  • Corneal scars

It is less successful for those who have corneal infection and severe injury, like a chemical burn.

In rare cases, the new cornea is rejected for no apparent reason. Another transplant can be attempted, though, and the outcome is often good.

To avoid complications, follow your doctor’s advice, use medications as recommended, and attend all follow-up appointments.

Call Your Doctor If Any of the Following Occurs

It is essential for you to monitor your recovery once you leave the hospital. That way, you can alert your ophthalmologist to any problems immediately. If any of the following occur, call your doctor immediately:

  • Decreased vision
  • Increased redness of the eye
  • Increased pain
  • Increased sensitivity to light
  • Flashing lights
  • Floaters—dust-like specks or threads in your line of vision
  • Loss of peripheral vision
  • Signs of infection, including fever and chills
  • Cough
  • Shortness of breath
  • Chest pain
  • Severe nausea or vomiting

RESOURCES:

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

National Eye Institute, National Institutes of Health
http://www.nei.nih.gov

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

CANADIAN RESOURCES:

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

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

References:

Cornea transplant: transplant surgery—what to expect. National Keratoconus Foundation website. Available at: http://www.nkcf.org/transplant.html . Accessed September 7, 2005.

Corneal surgery. The University of Mississippi Medical Center Department of Ophthalmology Services website. Available at: http://ophthalmology.umc.edu/cornea.html . Accessed September 8, 2005.

Corneal transplantation. Cole Eye Institute website. Available at: http://www.clevelandclinic.org/eye/patient_info/corneal_trans.asp . Accessed September 1, 2005.

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#4 . Accessed September 7, 2005.

Frequently asked questions. Eye Bank Association of America website. Available at: http://www.restoresight.org/general/faqs.htm#1 . Accessed September 8, 2005.

Medical encyclopedia: corneal transplant. National Library of Medicine and National Institutes of Health Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/003008.htm . Accessed September 1, 2005.

Retinal detachment. SUNY State College of Optometry website. Available at: http://www.sunyopt.edu/uoc/ret_detach.shtml . Accessed September 8, 2005.

Sutphin J. Eye donor awareness: frequently asked questions. University of Iowa’s Virtual Hospital website. Available at: http://www.vh.org/adult/patient/ophthalmology/faq/eyedonor.html . Accessed September 7, 2005.

What happens during corneal transplant surgery? Wills Eye Hospital website. Available at: http://www.willseye.org/patients/topics/cornea/faq/ . Accessed September 8, 2005.



Last reviewed December 2007 by Alexander J. Anetakis, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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