Know All About Cornea Transplant

CONTENTS

How Do I Fix Vision Loss?

The cornea is an integral part of the eye. It acts as the eye's outermost lens that controls and focuses the entry of light into the eye. Some individuals suffer from Keratoconus, which is a condition that causes the cornea to weaken, get thinner and change shape, thereby leading to a distorted vision. Even though the exact cause of this condition is unknown, it may be a result of medical conditions like asthma and eczema or due to a genetic disorder. Fuchs' endothelial dystrophy, is a condition that occurs due to old age, where the functioning of the cells lining the inner cornea (the endothelium) begins to deteriorate, resulting in cloudy vision. In some cases of damage to the cornea (corneal perforation), there can be injury or severe infection.


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A Cornea Transplant can cure vision loss, cloudy vision and corneal injury.

What Is Cornea Transplant?

A corneal transplant surgery aims at replacing a damaged or diseased cornea with a healthy donated corneal tissue (graft). It is an outpatient procedure that does not require an overnight stay in the hospital. The surgery can clear a patient’s blurred vision and cure various eye disorders or injuries like blindness, swelling and scars.

Alternate names for a cornea transplant include Keratoplasty and Corneal Graft.


Who Are The Ideal Candidates For Cornea Transplant Procedure?

You can consider getting a corneal transplant under the following circumstances:

Corneal failure after other eye surgery, such as cataract surgery

Keratoconus, a steep curving of the cornea

Hereditary corneal failure, such as Fuchs' dystrophy

Scarring after infections, especially after herpes

Rejection after a first corneal transplant

Scarring after injuries such as chemical burns or trauma

Individuals whose functional vision impede their ability to carry out daily activities.

Those whose vision cannot be corrected with special contact lenses or other less invasive measures.


What Are The Different Types Of Cornea Transplant?

The procedure aims to replace the damaged part of a patient’s cornea with a healthy donor tissue. There are different kinds of transplants, based on the nature of the cornea of the patient and the position of the part of the cornea that needs to be replaced.

DSEK (Descemet Stripping Endothelial Keratoplasty) - Refers to a partial thickness corneal transplantation in which a small amount of stroma (a layer of the cornea) and the innermost part of the cornea are transplanted to a defective cornea.

DALK (Deep Anterior Lamellar Keratoplasty) - This refers to transplantation of only the top and middle layers of the cornea, leaving the innermost layer (endothelium) of the patient intact. 

FEK ( Femtosecond laser Enabled Keratoplasty) – The newest approach to corneal transplantation uses a femtosecond laser to produce incisions in the cornea that enable the surgeon to exercise more precision in what is removed, so that the transplanted tissue perfectly fits into the cornea. This dramatically reduces postoperative astigmatism because of the precision of the laser, and it strengthens the wound site so that it is more resistant to traumatic opening in the event of eye injury following surgery.

 


 

What To Do Before A Cornea Transplant Procedure?

  • For 10 days before the surgery, you may need to limit medicines that make it hard for your blood to clot (blood thinners). Some of these are aspirin, ibuprofen, and warfarin.
  • You will need to stop eating and drinking after midnight, on the night before your surgery. You can however, consume water, apple juice, and plain coffee or tea (without cream or sugar) up to 2 hours before surgery.
  • Do not drink alcohol 24 hours before your surgery as it can constrict blood vessels and prolong recovery.
  • Do not put creams, lotions, or makeup on your face or around your eyes on the day of your surgery.
  • Arrange for someone to drive you home after your procedure.

 


 

What Is The Post-Operative Care For A Cornea Transplant Procedure?

  • 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. 

What Is The Diet For A Cornea Transplant Surgery?

Drink plenty of water. It flushes out the toxins from your body and keeps you hydrated.

Avoid sugar consumption as it weakens your white blood cells and hence the ability to fight infections.

Increase your consumption of carrots and other red, yellow, orange, and dark-green leafy vegetables. They contain beta carotene which helps in protecting the immune system.

Garlic is a good anti-bacterial food item which boosts the immune system. You should consume it to reduce the recovery time.


Realistic Expectations

  • Cornea transplant, also called corneal graft primarily aims to replace the damaged tissue with the healthy one, but there is no assurance that your eyesight will become 20/20 after the transplant.

  • In many cases, where the transplant procedure takes place in youngsters, perfect vision is a result. 

  • It is possible that your eyes do not get accustomed to the new tissue and you need to wear glasses or contact lenses. In addition, it is realistic to expect that the eyes will take a good while to adjust to the healthy cornea tissue of the donor and it might take a while before the quality of your eyesight reaches its peak.


What Are The Pros And Cons Of Cornea Transplant?

  • Pros

  • Cons

  • It helps to improve visual acuity by replacing the opaque or distorted host tissue (from the patient’s eye) with a clear and healthy donor tissue. 
  • It also functions as a reconstructive surgery where it is used to preserve the anatomy and integrity of the cornea of the patient. The anatomy and integrity of the Cornea refers to the slight dome like shape that the cornea represents over the pupil, which is ideal for refracting the light falling on it and making it hit the lens. But sometimes, due to some genetic ailments or injuries, the shape of the cornea can get non-ideal which deters vision. 
  • A benefit of corea transplant is that it can be used extensively when removing inflamed/damaged cornea which could have occurred due to some infections that didn't respond to antibiotics or antivirals. 
  • Cornea transplant aka keratoplasty helps to improve the physical appearance of the person by replacing cornea damaged by physical stress which could have left a white, opaque scar.

  • In a Cornea Transplant, there exists a risk of Graft Rejection, where the host tissue in the eye does not accept the graft tissue. This leads to redness, itching, inflammation etc. Recent studies conducted show that this can be easily avoided by doing Blood Group Matching rather than Tissue Matching between the Host and Donor. 
  • There is a risk of Infection. As the Cornea isn't supplied with blood, healing of the transplantation would take a longer time. Longer time gives more window for an infection.  This is greatly minimized by the use of a suitable antibiotic even before infection can occur. 
  • Increases the risk of Cataracts. Cataract Surgery has become relatively safe over the decades and is no longer a wonder. 
  • Some patients may experience problems with the stitches on the cornea. But this is a risk in almost every surgical procedure. This can be overcome by getting treated by professional surgeons with great expertise.

Who Should Avoid Undergoing Cornea Transplant?

A corneal transplant treats a number of illnesses, such as:

  • Thinning of cornea
  • Keratoconus
  • Scarring of cornea 
  • Corneal ulcer

It is, however, inappropriate for individuals who already have a damaged eye and might get exposed to greater risk through the treatment. In addition, cornea transplant should not be the choice for individuals who have a susceptibility to develop cataracts. One of the complications of the procedure is cataract and the chances for it might increase with the transplant.

 


 

What Are The Alternatives To Cornea Transplant?

Epidescemetic Keratoprosthesis - An effective surgical alternative to cure corneal blindness is the epidescemetic keratoprosthesis, where an artificial cornea, made of a biocompatible polymer  is designed to replace the anterior cornea. This alternative is generally opted for when a donor tissue for corneal transplant  is not available. 
 

Phototherapeutic keratectomy - PTK is one of the latest advances in eye care, used at a treatment for corneal dystrophies, scars, and infections, in which thin layers of diseased corneal tissue are vaporized microscopically and surface irregularities are etched away, with the help of excimer laser. This procedure involves improved precision which minimizes damage to the healthy adjoining tissues.

 


 

Does Cornea Transplant Lead To Scarring?

Cornea transplant can result in minor scarring in some cases but it is not affect vision in any way.

 


 

What Are The Temporary Side-Effects Of Cornea Transplant?

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.

 


 

How To Choose A Surgeon For A Cornea Transplant Procedure?

The procedure involves the removal of the damaged part of the cornea through the use of a trephine. Then the donor cornea is stitched in the place using fine nylon structures. 

The surgeon you choose should possess extensive knowledge of the procedure and should know how to best avoid the risks. Looking into the surgeon's educational and training background is a good approach to choosing the right surgeon. The risks associated with corneal transplant, like cataract, infection of eye, glaucoma, scarring of eye, loss of vision, swelling of cornea can be minimised with making the right surgeon choice.

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