Cornea Transplant Procedure

Overview

A corneal transplant, also known as keratoplasty, is a type of surgery where a surgeon replaces damaged or unhealthy corneal tissue with healthy tissue from a donor. The cornea is a clear, curved layer at the front of the eye that lets light enter and focuses vision.

Reasons for a corneal transplant include:

Restoring vision lost from damage or disease.
Reducing eye discomfort or pain.
Improving how the eye looks if the cornea is scarred.

Corneal transplant surgeries usually succeed, but patients may still experience problems, such as the body rejecting the donor cornea. An eye doctor performs the procedure to help people see better and relieve symptoms caused by corneal issues.

Reasons for Cornea Transplant

A cornea transplant becomes necessary when the clear, front part of the eye becomes damaged or unhealthy, impacting vision or causing pain. Common medical reasons include:

Keratoconus (cornea bulging)
Bullous keratopathy (corneal swelling with blisters)
Fuchs’ dystrophy (inherited corneal disease)
Corneal scars from infections or injury
Corneal edema (swelling)
Corneal dystrophy (genetic conditions)
Non-healing corneal ulcers
Problems after cataract surgery or Lasik, like pseudophakic bullous keratopathy
Chemically burned or damaged corneas

A transplant can also help treat severe refractive error and astigmatism if other treatments are not effective. Restoring corneal health with a corneal graft helps improve sight and reduce discomfort.

Possible Risks

Patients might develop several possible issues after a cornea transplant. The most common complications are:

Infection: Bacteria or fungi may enter the eye, leading to conditions like corneal infection or fungal keratitis.
Increased Eye Pressure: Some people may develop glaucoma after surgery.
Stitch Problems: The stitches holding the new cornea can sometimes cause pain or irritation.
Rejection or Graft Failure: The body might attack the donor cornea, which could lead to graft rejection or complete graft failure.
Bleeding and Retinal Problems: Bleeding inside the eye or issues like retinal detachment can also occur.

Warning Signs of Donor Cornea Problems

Watch for symptoms that may mean the immune system is attacking the transplanted cornea. Common warning signs include:

Symptom	Details
Loss of vision	Sudden or increasing vision loss
Eye pain	Persistent or sharp discomfort
Redness	Red appearance in the white of eye
Light sensitivity	Discomfort or pain from bright light

If you notice any of these signs, see an eye doctor right away to prevent further complications.

Steps Before Surgery

Getting the Right Donor Corneal Tissue

The first step is finding a suitable cornea to use in surgery. Most donor corneas come from people who have recently passed away. Eye banks check the donated eye tissue to make sure it is healthy and free of infections or eye diseases.

Reputable eye banks carefully screen donor eyes to avoid the use of tissue from anyone with an unknown cause of death, certain diseases, or previous eye surgery. Cornea transplants do not usually require tissue matching like kidney or liver transplants. Most people who are waiting for corneal tissue do not have to wait very long, especially in regions where donor tissue is readily available.

The availability of suitable donor corneas allows doctors to schedule surgery without long delays. Doctors use various tests and equipment to measure the patient’s eyes. This ensures the new corneal tissue is correct in size and shape, which is important for a successful transplant and clear vision.

Step	What Happens
Screening	Eye banks inspect the donor eye for diseases and prior surgeries.
Matching	Doctors select tissue with the correct size and health.
Approval	Medical clearance finalizes the selection for surgery.

Doctors may review all medications and supplements that the patient is taking, since some medicines must be stopped before or after surgery. They also make plans to treat unrelated eye problems, such as infections or swelling, to make sure the eye is healthy enough for the new tissue.

Types of Corneal Transplant Operations

Doctors use several methods to replace part or all of the diseased cornea with new tissue. The approach depends on the condition of the patient’s cornea and the location of the damaged tissue.

Full Thickness Keratoplasty (PKP)

Surgeons perform penetrating keratoplasty (PKP) to replace the entire thickness of the cornea. The surgeon makes a precise circular cut to remove a section of the patient’s damaged corneal tissue. Donor tissue, shaped to fit, goes into the opening, and the surgeon sews it in with tiny stitches. These sutures may be removed at a later date, depending on the healing process.

Endothelial Keratoplasty (EK)

In some cases, only the inner layers of the cornea need replacement. The main types are Descemet’s stripping endothelial keratoplasty (DSEK) and Descemet’s membrane endothelial keratoplasty (DMEK):

DSEK replaces the endothelium and part of the underlying tissue.
DMEK uses even thinner donor tissue, just the endothelium and Descemet’s membrane.

Both DSEK and DMEK suit patients with specific problems affecting the back part of the cornea. These methods often offer faster recovery and fewer complications.

Anterior Lamellar Keratoplasty (ALK)

Surgeons use this surgery when only the front or middle layers of the cornea are damaged. There are two main forms:

Superficial anterior lamellar keratoplasty (SALK) replaces only the top layers, keeping the healthy central and inner parts in place.
Deep anterior lamellar keratoplasty (DALK) is used if deeper stroma layers are unhealthy but the inner lining is undamaged. The surgeon removes the affected layer and grafts healthy donor tissue onto the eye.

Artificial Cornea (Keratoprosthesis)

If donor tissue is not suitable or available, some patients receive an artificial cornea. This type of replacement uses a man-made device to restore vision, but doctors use it only when regular donor transplants are not an option.

Each patient receives an individualized review and plan for a safe and effective procedure. Your doctor will explain which procedure best fits your condition and answer any questions you have about corneal transplantation.

What You Can Expect

How the Surgery Is Performed

On the day of a corneal transplant, the medical team usually gives patients either local anesthesia to numb the eye or general anesthesia to help them relax and prevent pain. The surgery is most often done on one eye at a time. An eye surgeon carefully removes the damaged tissue and replaces it with healthy corneal tissue.

The procedure typically takes place on an outpatient basis, so patients can go home the same day. Sometimes, the surgeon uses stitches to keep the new cornea in place. In some cases, the surgeon uses an air bubble to help hold the tissue during healing.

Step	Description
Anesthesia	Numbs the area or helps relaxation.
Replacement	Surgeon inserts donor tissue.
Placement Aid	May use stitches or an air bubble.

What Happens After Surgery

After surgery, patients need to use special eye drops, such as steroids or medications to prevent infection and swelling. These drops also help lower the risk of the body rejecting the new cornea. Most people wear a protective eye shield or glasses, especially at night or while sleeping, to prevent injury.

Recovery time varies; vision might be blurry for weeks or months. The medical team provides eye care instructions to prevent problems, including not rubbing the eye and avoiding strenuous activity until cleared by the surgeon. Patients attend regular follow-up visits with an eye doctor to track healing and make sure there are no complications.

Outcomes

Most patients who have a cornea transplant regain at least some vision. The degree of improvement depends on their original eye conditions and overall health. Sometimes, vision may appear more blurred than before at first. This is normal while the eye adjusts to the new cornea.

Improvement in visual acuity usually happens over several weeks or even months. The outer layer of the cornea needs time to heal before clear vision returns. During this period, an eye doctor monitors progress. Common factors affecting vision after surgery:

Factor	Details
Healing time	Can range from weeks to several months.
Astigmatism	Caused by irregular shape or stitches.
Refractive errors	May lead to nearsightedness or farsightedness.

Astigmatism often occurs because stitches may cause the cornea to become uneven. This sometimes makes vision look distorted or blurry. The doctor may reduce this by removing or adjusting stitches.

Other vision problems, like decreased vision or continued blur, can be managed with glasses, contact lenses, or, in some cases, laser surgery. Patients need regular check-ups since the risk of cornea rejection remains for many years after the procedure. Medications can help manage rejection if it occurs.