Corneal Transplant: Treatment, Procedure, Cost and Side Effects

Corneal grafting.

Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue (the graft). When the entire cornea is replaced it is known as penetrating keratoplasty and when only part of the cornea is replaced it is known as lamellar keratoplasty. Keratoplasty simply means surgery to the cornea. The graft is taken from a recently dead individual with no known diseases or other factors that may affect the chance of survival of the donated tissue or the health of the recipient.The cornea is the transparent front part of the eye that covers the iris, pupil and anterior chamber. The surgical procedure is performed by ophthalmologists, physicians who specialize in eyes, and is often done on an outpatient basis.

Donors can be of any age. The corneal transplantation is performed when medicines, keratoconus conservative surgery and cross-linking cannot heal the cornea anymore.The risks are similar to other intraocular procedures, but additionally include graft rejection (lifelong), detachment or displacement of lamellar transplants and primary graft failure.There is also a risk of infection. Since the cornea has no blood vessels (it takes its nutrients from the aqueous humor) it heals much more slowly than a cut on the skin. While the wound is healing, it is possible that it might become infected by various microorganisms. This risk is minimized by antibiotic prophylaxis (using antibiotic eyedrops, even when no infection exists).

On the day of the surgery, the patient arrives to either a hospital or an outpatient surgery center, where the procedure will be performed. The patient is given a brief physical examination by the surgical team and is taken to the operating room. In the operating room, the patient lies down on an operating table and is either given general anesthesia, or local anesthesia and a sedative.With anesthesia induced, the surgical team prepares the eye to be operated on and drapes the face around the eye. An eyelid speculum is placed to keep the lids open, and some lubrication is placed on the eye to prevent drying. In children, a metal ring is stitched to the sclera which will provide support of the sclera during the procedure most instances, the person will meet with their ophthalmologist for an examination in the weeks or months preceding the surgery. During the exam, the ophthalmologist will examine the eye and diagnose the condition.

The doctor will then discuss the condition with the patient, including the different treatment options available. The doctor will also discuss the risks and benefits of the various options. If the patient elects to proceed with the surgery, the doctor will have the patient sign an informed consent form. The doctor might also perform a physical examination and order lab tests, such as blood work, X-rays, or an EKG.The surgery date and time will also be set, and the patient will be told where the surgery will take place. Within the United States, the supply of corneas is sufficient to meet the demand for surgery and research purposes. Therefore, unlike other tissues for transplantation, delays and shortages are not usually an issue.

Any cornea deemed suitable for transplantation can be grafted into any recipient, regardless of recipient age, race, and blood type. Eye banks, in concert with guidance from the Eye Bank Association of America (EBAA) and Food and Drug Administration (FDA), help set policies and procedures that guide suitability determinations for cornea transplantation and proper storage and handling of transplant tissue. There is a 24-hour window of opportunity from the time of a donor's death to procure a cornea and place it in storage media. Unlike organ donation, in which procurement is extremely limited by time and the immediate availability of a potential recipient, corneoscleral tissue can be stored and used up to 14 days after procurement before it expires.

The bottom line is that for the vast majority of transplants for endothelial failure, the donor age does not matter much. More concerned factor is about the health of the tissue. It is to be admitted now would not never be eager for tissue from donors older than 72 years of age. If anything, these results will encourage me to use older donor tissue (but only in my older patients), because the results were not markedly different from those in the younger donors. For (the rare) very young patients with endothelial disease, younger donor tissue would be tried. The Corneal Preservation Time Study, which is currently completing enrollment, is looking at graft survival after DSEK.

The side effects of cornea graft need to be known well in advance of the surgery, so that you can handle them. Though the full recovery time of eyesight can last as long as a year, the clear vision, or the effect of cornea transplant also lasts for a long time, if not forever. Temporary and common complications include: Redness of eye,Sensitivity to light,Flashing lights/floaters in your field of vision ,Slight discomfort ,Pain in the eyes,Nausea.Any of the above mentioned side effects, if experienced, need to be conveyed to the doctor in order for you to prevent their aggravation at a later stage. The surgery and the organ on which it is performed is delicate. Remember, the eye is at risk of further damage in the absence of adequate care, before, as well as after the surgery.

You must not rub or touch your eye postoperatively. Avoid getting water and soap into your operated eye for one to two 1–2 months. An important after care step is to stay away from dusty and crowded environments. Avoid strenuous exercises for four to six 4–6 weeks. Swimming and contact sports should also be restricted for 6–9 months, until all recovery stages are complete.You will need to wear an eye shield when you sleep to prevent rubbing your operated eye during sleep. Wear sunglasses to avoid excessive glare when you go outdoors. Some patients require medication for at least a year. These drops include antibiotics to prevent infection as well as corticosteroids to reduce inflammation and prevent graft rejection.For the first few days after surgery, the eye may feel scratchy and irritated. Vision will be somewhat blurry for as long as several months.Sutures are often left in place for six months, and occasionally for as long as two years. Some surgeons may prescribe rigid contact lenses to reduce corneal astigmatism that follows corneal transplant.

Patients can expect restored vision after the healing process is complete. In some patients, this might take as long as a year. Patients with keratoconus, corneal scars, early bullous keratopathy, or corneal stromal dystrophies have the highest rate of transplant success. Corneal transplants for keratoconus patients have a success rate of more than 90%.

Cornea transplant is one of the most common transplant treatments worldwide and nearly all major hospitals in major cities across the world provide this facility.The price ranges from Rs 1.5 Lakh to Rs.1.7 Lakh in India.

Corneal transplants are highly successful, with over 90% of the operations in United States achieving restoration of sight. However, there is always some risk associated with any surgery.Most people experience at least partial restoration of their sight, and some will continue to require prescription eyewear. Full recovery may take up to a year, but recovery times are decreasing as techniques improve.