Cornea Transplant Specialists
If your cornea cannot heal or repair on its own, your doctor may recommend a corneal transplant. During this surgery, the damaged portion of the cornea is replaced with a clear, healthy cornea from a human donor. Our doctors’ extensive training in corneal transplantation can restore your vision.
How Common are Cornea Transplants?
Each year doctors perform roughly 40,000 cornea transplants. In the U.S. Corneal transplants have the highest success rate of any type of tissue graft. Success rates vary depending on the condition that necessitated a transplant procedure. By choosing a highly trained doctor you can further reduce your already low risk of complications. Only you and your doctor can decide when a corneal transplant is right for you.
What is a Cornea Transplant?
Corneal transplant is surgery that replaces a damaged or diseased cornea with a healthy donor cornea. There are a few different types of corneal transplants. The cornea is sometimes only partially replaced with new tissue and then there are times when replacement of an entire cornea is necessary. Recovering clear vision may take up to a year or more after surgery. It is possible that the body will reject a transplanted cornea which may then require another transplant surgery.
Am I a Candidate for Cornea Transplant?
Doctors use corneal transplants to treat various conditions that cause the cornea to become swollen or scarred. A tissue transplant can improve your vision in the event that the more conservative treatment options fail.
Doctors recommend a corneal transplant to treat the following conditions.
- Scarring from infections
- Genetic Diseases
- Conditions that cause the cornea to take on an irregular shape.
- Scarring from trauma like burns
- Rare complications associated with refractive or cataract surgery.
What Causes Cornea Problems?
Some common eye disease and injury problems that can lead to a damaged cornea include:
- Keratoconus – the cornea is cone-shaped rather than dome-shaped
- Fuchs’ dystrophy – cells in the inner layer of the cornea are not working effectively, leading to swelling of the cornea
- Eye infections or injuries that scar the cornea
- Previous corneal surgery or other
- eye surgery that damaged the cornea
What are the Different Types of Cornea Transplants?
Though there are multiple cornea transplant surgeries that ophthalmologists perform, the SightMD team primarily relies on three types:
Full Thickness Corneal Transplant
If there is damage to both the front and back corneal layers, your entire cornea might need replacement. Penetrating keratoplasty (PK), or full thickness cornea transplant results in the removal of your diseased or damaged cornea. After the removal the clear donor cornea is sewn into place. PK has a longer recovery period than other types of cornea transplants. Getting complete vision back after PK may take up to 1 year or longer and with a penetrating keratoplasty, there is a higher rejection risk than with other types of corneal transplants. Rejection occurs when the body’s immune system attacks the new corneal tissue.
Partial Thickness Corneal Transplant
Sometimes damage occurs in the front and middle layers of the cornea and in this case removal of only those layers is needed. The endothelial layer, or the thin back layer remains in place. This type of transplant is called deep anterior lamellar keratoplasty (DALK), a type of partial thickness corneal transplant. DALK is used to treat keratoconus or bulging of the cornea. Healing time after DALK is shorter than after a full cornea transplant and there is also less risk of having the new cornea rejected.
In some conditions damage occurs in the innermost layer of the cornea called the “endothelium” which causes the cornea to swell, affecting your vision. Endothelial keratoplasty is a surgery to replace this layer of the cornea with healthy donor tissue. It is a partial transplant since replacement only happens for this inner layer of tissue.
There are two types of endothelial keratoplasty.
- DSEK (or DSAEK)
Each type removes damaged cells from an inner layer of the cornea called Descemet’s membrane. The surgery starts with the damaged corneal layer removed through a small incision. After placing the new tissue, only a few stitches—if any—are needed to close the incision. Much of the cornea remains untouched which lowers the rejection risk of the new cornea cells.
Some things to know:
- With DSEK/DSAEK surgery, the donor tissue may be easier to transplant and position because it is thicker than the donor tissue in DMEK surgery.
- In DMEK surgery, the donor tissue is thin and can be more difficult to transplant. But recovery is quicker because the transplant tissue is thinner.
- Your eye surgeon will choose the type of surgery based on your cornea’s condition.
What to Expect with a Cornea Transplant
Days or weeks before your transplant
Your ophthalmologist will talk with you about corneal transplant surgery. You will discuss why you need this surgery, how it can help you see better, and what you can expect during and after surgery. Once you decide to have a corneal transplant you will schedule a tentative date which may change if a good donor cornea is not ready for you at that time, though this is rare.
The day of your transplant
The cornea transplant is an outpatient procedure. Your doctor will start by inserting eye drops into your eyes and if needed you may also receive other medications to help you relax. An anesthesiologist will administer either local or general anesthesia, so you do not feel pain. Your ophthalmologist will then put a device on your eye to keep it open. Even though your eye is open, you will see very little or nothing at all because of the anesthesia. Your eye surgeon at this point will have chosen how to transplant the healthy donor cornea based on your specific need. In some cases, they may remove a circular part of your cornea then replace it with a matching portion of the donor cornea, stitching it into place. Sometimes they will remove only a very thin layer of cells from the front of the cornea. Replacing them with donor corneal tissue and stitching it into place. In other cases, the surgeon will remove only the damaged inner layer of the cornea. After the doctor puts a thin disc of healthy donor tissue on the back surface of the cornea. An air bubble is then put in the eye to push this new cell layer into place so the cornea can heal. Sometimes your ophthalmologist may repair other eye problems during the same surgery, such as cataracts.
After your transplant
After surgery, your ophthalmologist usually tapes a shield over your eye to keep it covered. You will be monitored after surgery to make sure you recover from the anesthesia and can safely go home. Your ophthalmologist will explain what to do to care for yourself at home after surgery.
You will be home the same day! The day after your corneal transplant surgery, you will need to go back to your ophthalmologist’s office to have your eyes checked.
It may or may not be necessary to remove the stitches after surgery. This depends on how quickly you heal, the health of your eye, and the type of stitches used.
As you recover from surgery, these are things you need to do to care for your eye:
- Use the eye drops exactly as the ophthalmologist prescribed.
- Do not press on or rub your eye.
- If needed, take over-the-counter pain medicine. Ask your doctor which ones you can take.
- Wear eyeglasses or an eye shield to protect your eyes.
- Talk to your doctor about when you can get back to doing your normal daily routine.
- Call your ophthalmologist if you have concerns or questions about how to care for yourself at home.
Depending on the type of transplant you had and how your eye heals, it can take a year or more to fully recover from this surgery.
What are Possible Problems with Corneal Transplants?
Organ rejection is when the body’s immune system sees transplanted tissue as something that shouldn’t be there and tries to get rid of it. Rejection is a problem for up to 3 out of 10 people who have a corneal transplant. It is more common with full-thickness transplants than partial-thickness transplants.
Warning signs of your body trying to reject your cornea transplant include:
- Eye pain
- Being extra sensitive to light
- Redness of the eye
- Cloudy or hazy vision
Tell your doctor right away if you have any of these signs. He or she might be able to stop the rejection with medicine.
Sometimes corneal transplant can cause other eye problems such as:
- Detached retina (where the tissue lining the back of the eye pulls away from the eye)
- Glaucoma (increased pressure inside the eye)
Even if your corneal transplant is successful, your vision may be limited. It is possible for the new cornea to be irregularly curved (called astigmatism). Another possibility is that you have an eye disease such as macular degeneration, glaucoma, or diabetic retinopathy.
Some people may need more than one corneal transplant if rejection or other complications arise. A repeat transplant has a higher rate of rejection.
An Opportunity for Clear Vision
If you have a damaged cornea, you and your ophthalmologist will discuss your options for improving your vision. For people with a deeply scarred or swollen cornea, transplant surgery can restore clear vision.