A corneal transplant is an eye surgery. It implies removing a segment or all of your own cornea and then replacing it with another one which came from a healthy donor. If you are interested in going through this procedure, here is all you need to know.
What Is the Cornea?
The first thing you need to know is what is the cornea in itself, and why does it require a transplant. The cornea is a clear layer which sits just outside the front of your eye. One can picture it as a window that protects the eye itself from debris and damage. You can typically see the iris or the colored part of your eye as well as the pupil, the black dot inside the iris, through the cornea.
Apart from protecting these two vital elements of the human eye, the cornea does other things as well. It focuses the light which gets captured onto the eye on the retina. This is a film at the back of the eye, and it’s very sensitive to light. The light which the cornea captures is transformed into a ‘picture’ and transmitted to the brain.
In very broad terms, this is how we manage to see. Therefore, you can now understand just how crucial a part the cornea plays. Any damage that befalls it might have severe consequences on your sight. For example, when the cornea suffers some injuries, it can get either less clear or transparent or change its shape. If this happens, then the light won’t be able to penetrate the eye in the same way. As a consequence, the ‘picture’ that is supposed to reach the brain might become blurry, shadowed or distorted.
Why Do You Need a Corneal Transplant?
Apart from what we mentioned above, here are the reasons why one might need a corneal transplant.
- Keratoconus. This is a disease which makes the cornea weaken and turn thinner. It will also change its shape due to this condition. 1 in 3, 000 to 1 in 10, 000 people have Keratoconus. Specialists and doctors do not know the exact reason why this happens. It could be something genetic. However, they have noticed that it is a lot more common in people who already suffer from asthma, eczema or several allergies.
The condition appears largely in younger individuals. It usually develops in their early teenage years and sometimes even earlier.
The best part of all cases is considered to be mild. Therefore, the patients require nothing but lenses or glasses. However, there are some cases which take a turn for the worse. These are the patients who need a corneal transplant.
- Degenerative conditions. There are some conditions which worsen over time and cause the eyes to develop further problems over the years. One such example is Fuchs’ endothelial dystrophy. It is a condition in which the cells that typically line the inside of the cornea start to deteriorate.
The older the patient gets, the faster it happens. As the eyes weaken, the allow the fluid to build up instead of clearing it. Therefore, the patient will suffer from blurred vision.
- Perforation of the cornea, due to damage, such as a blow to the head, for example, or debris making its way in there.
- Infections in the corneal area which have failed to respond to a course of antibiotics.
- Scarring of the cornea due to injuries or previous infections.
How Does a Corneal Transplant Work?
There are several ways in which your doctor can conduct your transplant. They all depend on what segment of your cornea has damages or problems. It also depends on how big a corneal replacement you need.
Here are your options.
- PK or penetrating keratoplasty. It means that you require a full-thickness transplant.
- DALK or deep anterior lamellar keratoplasty. In this case, they will replace or reshape the outer and median or front layers of your cornea.
- EK or endothelial keratoplasty. It replaces the back or deeper parts of your corneal layer.
As far as the anesthesia goes, the doctor can put you completely under, which means that you will be asleep as it happens. If not, you can opt for partial anesthesia. The local area will be numb, but you will be fully awake and aware of what is happening.
The operation in itself will typically last approximately one hour. Depending on your particular case and health problems, you may be allowed to leave the hospital immediately or spend the night. The latter option happens in case the doctors want to keep you under supervision a while longer.
If your procedure involves removing your outer cornea and replacing it with healthy tissue, then the new one must be held in place by stitches. They have to remain in position for 12 months.
The EK or endothelial keratoplasty or transplant does not need any stitches. They insert an air bubble into your eye to keep the new piece of the cornea in place for a few days. After that, it will stick to your own cornea in a natural way. However, should this be your case, you need to discuss what you have to do with your doctor.
For example, you have to make sure that you don’t receive any blows to the head in that time or that you sleep in a particular position. If not, the air bubble can easily move from its original place, and the new corneal transplant will not stick.
What About the Risks of a Corneal Transplant?
Just like with any other type of surgery, there are some risks when it comes to a corneal transplant as well. For example, your body may very well reject the new tissue. The project of rejection happens when the patient’s immune system fights against the newly received tissue. It recognizes it as a part that does not naturally belong to you and starts to attack it.
This is, probably, the one risk you must be acutely aware of, as it is the most common. In fact, when it comes to a corneal transplant, one in five patients goes through this. The rejection in itself can happen a few weeks after you have had the transplant. However, you can typically experience it after a few months.
If you go to your eye doctor as soon as you notice the symptoms, then it is manageable. He or she will most likely prescribe you some steroid eye drops and the problems will stop in this way.
Another type of risk or complications is the following.
- Red eyes
- Photophobia or sensitivity to light
- Have problems with your vision in that your sight is blurry or clouded.
- Feeling pain in the eyes.
- Astigmatism – a condition in which your cornea is no longer in its perfect shape
- Glaucoma – where pressure in your eye builds up because it has a lot of trapped fluid
- An inflammation of the eye’s middle layer called uveitis.
- Retinal detachment – as its name suggests, it’s a condition in which the retina or that thin layer of cells which you can find at the back of your eye starts to pull away. Generally, it should be perfectly aligned with the blood vessels which feed it with nutrients and oxygen.
- Seeing your original disease come back
- Your operation opening up and you suffering from ensuing trouble.
- Internal infections caused by the wounds you suffered from during your surgery.
What Happens After the Corneal Transplant?
As far as the recovery time is concerned, it will depend on the type of problems, as well as on the kind of surgery you have. As a rule of thumb, it will take approximately 18 months for you to enjoy the final results. That happens in the case of a full-thickness transplant. However, it is possible for you to get some glasses or some lenses earlier than that if need be.
If you are simply going to replace the outer or middle layers, then the recovery time is considerably smaller. These are the DALK surgeries. Out of all the surgery types, the EK or endothelial transplant is the one that heals the fastest. It typically takes a patient only a few months or maybe even a few weeks to get over it and enjoy the results.
Tip – it is very important for you to take care of your eye during the recovery time. This means that you have to avoid rubbing your eyes or any activities which might dislodge the operation. They include swimming, playing sports, running, and so on. You must not perform them until your doctor says it’s safe to do so.
Do You Qualify for a Corneal Transplant?
Here are a few questions you need to ask yourself prior to going for the transplant.
- Does the current state of your vision affect the way you perform at your job or how you carry out your daily tasks?
- Can you correct your vision with special glasses or lenses?
- In the same way, can you opt for some less invasive measures than surgery?
- Does your health insurance cover this operation?
- If not, will you be able to pay for everything, starting with the pre-screening and ending with the consultations that follow the surgery?
- Can you take all the time off that is needed to recover from the surgery? Sometimes it takes half a year to a whole year to heal. Can you arrange that at your job or school?
Apart from receiving a human cornea in your corneal transplant, you can also receive an artificial or biosynthetic one. Although this field has yet to be developed, it can be an option if they cannot find an available donor, one suited for your needs or if your body keeps rejecting the transplants. Please refer to your eye doctor before you make a decision.
Image source: 1