What is a Corneal Transplant?
The cornea is the transparent, dome-shaped surface of the eye where light enters. It plays a large role in your eye’s ability to see clearly. A corneal transplantation is a surgical procedure to replace part of your cornea with donor corneal tissue and restore vision, improve the appearance of a damaged cornea, or reduce pain.
There are a number of conditions that can be treated with a corneal transplant, including:
- Keratoconus.
- Fuchs’ dystrophy.
- Cornea scarring caused by injury of infection.
- Thinning or tearing of the cornea.
- Corneal ulcers.
- Swelling of the cornea.
- Complications due to previous eye surgery.
Preparation for Corneal Transplant
Before your cornea transplant surgery, you will need to undergo a comprehensive eye exam to asses the damaged or diseased cornea. This allows Dr. Gupta to look for any conditions that might cause complications after surgery and take measurements of your eye to determine what size of donated cornea is needed. You may also be asked to temporarily stop taking certain medications, such as aspirin, for a couple of weeks before your surgery. Dr. Gupta will speak with you regarding all preparation instructions prior to your procedure and risks, including cornea rejection.
KNOW YOUR DOCTOR
Dr. Archana Gupta
Cataract Surgeon, Ophthalmologist, Cornea & External Diseases Specialist
Dr. Archana Gupta is a board certified ophthalmologist. She specializes in cataract, cornea, external diseases and refractive surgery.
The Corneal Transplant Procedure
A corneal transplant is often done as an outpatient procedure under local anesthesia, so you can return home the same day. On the day of your surgery, you will be given a sedative to help you relax and a local anesthetic will be used to numb the eyes.
A cornea transplant removes either the entire or partial thickness of the diseased cornea and replaces it with healthy donor tissue. There are a number of different surgical methods to achieve this, which include:
Penetrating Keratoplasty (PK)
PK is also referred to as a full-thickness corneal transplant and it is often required when the cornea is severely damaged. During this procedure, your surgeon will cut through the cornea to remove a small disk of corneal tissue. Donor tissue will then be inserted to take its place and sutured in place. After surgery, you will need to wear an eye shield to keep your healing eye protected and use topical antibiotics and corticosteroids to prevent infection and graft infection. Full recovery can take 6-12 months but the success rate of this surgery is very high and many patients enjoy an improved quality of life.
Endothelial Keratoplasty (EK)
EK is a type of corneal transplant that replaces the damaged inner lining of the cornea – the endothelium. The procedure only requires a single small incision and the damaged tissue is removed with a microkeratome blade. These are also used in LASIK surgery. The donor tissue will be carefully folded and fitted through the incision, then positioned inside the eye. An air bubble will be carefully injected to position the graft and help it unfold. Your vision will start to improve within 2 weeks and continue to gradually improve over 4-6 months.
Descemet Stripping Endothelial Keratoplasty (DSEK)
DSEK can restore clear vision by correcting corneal endothelium failure. This is a partial-thickness cornea transplant that replaces the endothelium and Descemet’s membrane just above it. First, the endothelium and Descemet’s membrane are carefully stripped away through a small incision and then a circular disc is removed from the inner lining of a donor cornea. The donor tissue will be carefully placed with a small air bubble that stabilizes the area during the first day after surgery. After surgery, patients should lie on their backs and rest as much as possible to keep the air bubble stabilized.
Descemet Membrane Endothelial Keratoplasty (DMEK)
DMEK is another type of partial-thickness corneal transplant that only replaces the endothelium – the innermost layer of the cornea. Healthy corneal tissue is left in place to shorten the treatment and recovery time. During the procedure, you will be given a topical anesthetic to numb your eye but you will not have to undergo sedation. Small incisions will be made in the cornea and then the new donor tissue is inserted into your eye. An air bubble will keep it in place as it heals. Once the area is secured with sutures, you can relax in your treatment room for about one hour while you are monitored to ensure there are no complications. Continue to rest at home for a couple of days until the air bubble pops and make to apply topical antibiotics and steroids as instructed.
Anterior Lamellar Keratoplasty (ALK)
ALK is performed to replace scared or damaged cornea tissue on the front (anterior) layer. This procedure often benefits patients with refractive issues like nearsightedness or farsightedness. During the procedure, the cornea is dissected into two pieces and a thin layer of the damaged tissue is removed. Healthy donor tissue will be grafted into place and sutures may be used, depending on the specific technique used. Clearer vision will gradually improve for a few weeks after surgery.
Corneal Transplant Recovery
After corneal transplant surgery, you may need to wear an eye patch for a while as your cornea heals. Eye sensitivity, redness, and soreness are common for the first few days. Prescription eye drops can help to bring down any inflammation that occurs, as well as lower the chances of infection. It can take several months for your overall vision to improve. Dr. Gupta will give you specific instructions regarding your recovery for the best results.
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