A corneal transplant is also called corneal grafting or keratoplasty. This sight-restoring procedure is usually reserved for situations when all other treatment options have been exhausted.
First performed in 1905, the operation involves replacing damaged or diseased cornea with donated, healthy tissue. It’s one of the most common types of organ transplants performed today and has a high success rate.
The majority of patients gain considerable visual improvement for many years.
Conditions where a corneal transplant may be recommended include:
Corneal transplant is usually recommended when all other treatments have been exhausted. A full examination will be performed and one of our ophthalmologists will discuss the benefits and the risks of surgery with you.
Full-thickness transplants (also called penetrating keratoplasty) are the most common corneal transplant procedure. If you suffer from keratoconus or corneal scarring and have exhausted all other forms of treatment, this procedure will most likely be recommended.
The cornea has five layers. Surgery involves cutting through all five corneal layers to remove the damaged or diseased section. The donor cornea, usually about the size of a small button, is then gently positioned into the opening and stitched into place. The stitches are removed at a later date.
If some of the corneal layers are undamaged or free from disease, a recent advance known as a partial thickness corneal transplant may be recommended. In this case, only the affected layers are removed. The surgeon does not cut through the entire thickness of the cornea.
These layers are replaced with layers of healthy donor tissue. Only a small area of the cornea is disturbed, usually resulting in a more stable outcome.
There are two types of partial-thickness corneal transplants:
A corneal transplant is a day-surgery procedure and usually takes about an hour.
Patients are given a sedative to ensure that they remain relaxed throughout the procedure and a local anaesthetic is used to numb the eye. The donor cornea will have already been tested to make sure it is healthy and free of disease or damage.
Your surgeon will use a microscope to perform the delicate surgery. Sutures are required and are made of a material that is finer than a human hair.
Afterwards, you will be taken to a recovery room to allow the effect of the sedative to wear off. You’ll then be discharged with eye drops and a protective eye patch. A post-operative check will be scheduled for the following day, and then regularly thereafter.
Following surgery, your corneal tissue will slowly grow and fuse to the donor tissue. Eyesight recovery is gradual and varies depending on the procedure. For penetrating keratoplasty, full recovery can take up to a year. This is mainly because of the time it takes for the tissue to heal properly and sutures removed.
The newer techniques are less invasive and recovery is generally faster. Regular post-operative visits will allow your ophthalmologist to monitor your progress and identify any complications. Eye drops, and occasionally oral medication, will be required to prevent swelling, infection and pain for at least 6 months.
Generally, corneal transplants are highly successful. Most people experience a considerable improvement in vision. However, glasses or contact lenses are often still required.
Your surgeon may need to adjust the stitches to create a regular and round corneal shape. Stitches can be removed anywhere from 6 months to 3 years later. If the corneal shape is not ideal following stitch removal, then laser eye surgery (ASLA) may be used for further reshaping.
It’s important to understand that the transplant will not last forever. How long it lasts depends on the reason for the transplant. For example, a transplant in a patient with keratoconus usually lasts 15 to 20 years.
Corneal transplants have a high success rate. But, like any surgery, there are always risks. These may include:
Rejection occurs in about 20% of corneal transplants and can happen at any time, even years or decades later. Sometimes a new injury or illness causes the rejection. Fortunately, in most cases rejection can be controlled by medication if treated early enough.
If you notice redness or blurred vision that persists for longer than 24 hours, contact your surgeon immediately.