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  • 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:

    • Keratoconus
    • Corneal scarring – due to a corneal ulcer, injury or infection (e.g. herpes keratitis)
    • Excessive corneal swelling and clouding – e.g. due to Fuch’s Dystrophy or corneal oedema

    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.

  • What is the cornea?

    The cornea is the clear, protective outer layer of the eye. Shaped like a dome, it protects the eye from foreign bodies. The cornea plays an important role in vision by refracting (bending) light entering the eye to help focus it on the retina. While minor abrasions tend to heal quickly, deeper corneal injuries can cause scarring.

    Where does the donor cornea come from?

    Almost anyone can donate their corneas or other parts of their eyes.

    Unlike organ donation, age and blood type are not factors in determining the suitability of a cornea donor. Neither is donor eye colour. Donated corneas are tested to make sure they are free from disease and damage. People with severe infections or diseases such as HIV and hepatitis cannot donate their corneas.

    Individuals can register with the Australian Organ Donor Register or tell their next of kin they wish to become a donor.

    What are the risks?

    Corneal transplants have a high success rate. But there are potential complications, including the risk of an eye infection, swelling, bleeding or a cataract developing. Rejection occurs in approximately 20% of cases, often as the result of a new injury or illness.

    How long does the operation take?

    A corneal transplant is performed as a day procedure and the operation itself takes about an hour. Recovery is gradual and it may take up to a year before you see the full results.

Full-thickness corneal transplants

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.

Partial-thickness corneal transplants

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:

  • Deep anterior lamellar transplant involves replacing all corneal layers except the deepest two. This procedure can be used to treat keratoconus and scarring due to injury or the herpes simplex virus.
  • Endothelial layer transplant (endothelial keratoplasty) replaces the deepest layer of the cornea that has been damaged by disease or injury, leaving the front layers intact. This procedure is commonly used to treat Fuchs’ endothelial dystrophy.

What to expect on the day of surgery

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.

Recovering from a corneal transplant

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.

Visual recovery

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.

Risks of a corneal transplant

Corneal transplants have a high success rate. But, like any surgery, there are always risks. These may include:

  • Eye infection
  • Rejection of the donor cornea
  • Cataract development
  • Problems with the stitches
  • Corneal swelling
  • Bleeding

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.

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