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Cornea Transplantation

‘Clang clang! Thump! Bang!’ as you turn around the corner, you notice your old car making funny noises. “Oh dear,” you say to yourself, “I wonder what part needs replacement now?” Seems like a humdrum situation that is commonly encountered by you.

Two centuries ago, if you were to make this comment with respect to your body, you would have been considered a lunatic.

What was science fiction yesterday is a reality today. Today we are able to replace or use other people’s body parts and make them our own. Although the entire eye is not one of them (yet), you can get yourself a new cornea if the one you were born with gets damaged or diseased.

What is the cornea?

Cornea is the dome shaped transparent front surface of your eye that helps in bending the rays of light so that the image of the objects we see are properly focused on the screen at the back of the eye (a structure called the retina).

What is Cornea Transplantation?

 

 

It is a surgical procedure in which a patient’s damaged cornea is removed and replaced with a normal cornea from a donor’s eye. It is also called keratoplasty.

When is this surgery performed? (Indications)

•    Scar formation on the cornea after injuries, chemical burns or infections
•    Rejection of a previous corneal transplant
•    Advanced stages of Keratoconus, a condition in which the cornea is steeply curved.
•    Corneal Dystrophy (A genetic condition in which the layers of the cornea are damaged affecting vision) like Fuch’s Dystrophy
•    Thinning or swelling of cornea
•    Corneal Ulcers

How do I prepare for the surgery?

Your doctor will perform a number of tests to see for the size of your cornea, and any conditions that may cause complications.

All your medications will be reviewed and you may be asked to stop a few prior the surgery.

Any other eye problems like infections will be treated before your surgery.

How is a corneal transplant done?

 

 

Once your ophthalmologist decides that you would require a corneal transplant, you can get yourself enlisted with a local eye bank. As soon as your name comes up on the waiting list, you are called when a cornea is available. The health of this donor cornea is tested for various diseases like AIDS and Hepatitis.

Corneal Transplantation is done on an outpatient basis, meaning that hospitalization is not required. Usually it is done using eye drops that numb your eyes. You will not be asleep during the operation but you should not experience any pain either. Your eyelids are kept open gently using special instruments. The entire surgery is performed under a microscope.

Your diseased cornea is carefully removed from your eye. If you require any additional surgery like the removal of a cataract, then this is done simultaneously. The donor cornea is cut to match your size and is sewn back in place. Depending on your eye’s condition, your surgeon may either perform a full thickness transplant or partial thickness (called lamellar) transplant. The latest advancements allow only the diseased part of cornea to be replaced. If the front part of cornea is damaged, anterior deep lamellar keratoplasty (DALK) is a great option and if the back most part of cornea is damaged then descemet’s stripping endothelial keratoplasty (DSEK) can be done.

After the operation, your eye will be covered with a protective shield. You will be allowed to go home a few hours after surgery. Do ensure that you have a friend or relative to accompany you home. You will be required to follow up the next day. Further weekly follow ups may be initially required after which they will be monthly as your surgeon deems necessary. Stitches if put (depending on the kind of surgery)are removed 3 to 17 months after surgery depending on your response.

What precautions am I required to follow after the surgery?

Do not rub or press your eyes

Wear sunglasses or eye shield as advised by your surgeon. Protect your eyes from injury.

Avoid strenuous activities or exercises. You may continue with your daily routine. You should be able to resume work 3 – 7 days after surgery.

Do not forget to use eye drops or other medications that have been prescribed to you.

What are the complications of keratoplasty?

•    Eye Infection
•    Increased risk of developing cataract (clouding of the lens)
•    Glaucoma (Increased pressure inside the eye)
•    Swelling of cornea
•    Astigmatism (A refractive error in which distant as well as near vision is affected)
•    Rejection of the donor cornea: This is seen in about 20% of cornea transplants. Rejection signs can occur as early as one month or as late as a few years after the surgery. The symptoms are pain, redness, loss of vision and sensitivity to light. This happens because your body’s immune system attacks the donor cornea considering it as a foreign entity. This requires a repeat transplant. Most rejections if treated promptly can be stopped with minimal injury.

When will my vision improve?

Vision may continue to improve up to a year after surgery. Initially your vision will be blurry. You will need vision correction glasses or lenses to counteract the nearsightedness or astigmatism. Your vision may fluctuate for the first 3 months. After healing is complete and the stitches have been removed, you can undergo LASIK to get rid of your glasses or lenses.