By Dr. Aayush Tandon, Corneal Transplant Specialist
Corneal transplantation, or Keratoplasty, is a remarkable surgical procedure that can restore vision for patients suffering from various corneal conditions. As a specialist in corneal transplantation, I’ve seen how life-changing this procedure can be, enabling patients to see clearly again. In this guide, I’ll walk you through everything you need to know about corneal transplantation, its types, and what to expect before, during, and after surgery.
What is Keratoplasty?
Keratoplasty is a surgical procedure where a damaged or diseased cornea is replaced with a healthy donor cornea. The cornea is the eye’s transparent outer layer, responsible for focusing light onto the retina. Damage to this critical part of the eye can lead to blurred vision, light sensitivity, and even blindness. Corneal transplants help to restore the clarity of this layer, improving overall vision.
Why Might You Need a Corneal Transplant?
Several eye conditions can lead to the need for a corneal transplant, including:
•Keratoconus: A condition where the cornea thins and bulges outward in a cone shape, distorting vision.
•Fuchs’ Endothelial Dystrophy: This hereditary condition causes the cornea’s inner layer to deteriorate, leading to swelling and vision loss.
•Corneal Scarring: Injuries, infections, or inflammation can scar the cornea, impairing its transparency and vision.
•Corneal Edema: Swelling of the cornea, often due to complications from previous eye surgeries.
When vision cannot be improved through corrective lenses or less invasive treatments, corneal transplantation may be the best solution.
Types of Corneal Transplants
There are different types of corneal transplants depending on the location and depth of corneal damage. As a specialist, I select the most appropriate type based on the patient’s condition. The three main types are:
1. Penetrating Keratoplasty (PK):
This is the traditional full-thickness corneal transplant where the entire damaged cornea is replaced with a donor cornea. It’s commonly used for patients with extensive corneal scarring or thinning.
2. Deep Anterior Lamellar Keratoplasty (DALK):
In this procedure, only the outer and middle layers of the cornea are replaced, while the healthy inner layer is preserved. DALK is used for conditions affecting only the outer layers, like keratoconus or scarring.
3. Descemet’s Membrane Endothelial Keratoplasty (DMEK) and Descemet Stripping Endothelial Keratoplasty (DSEK):
These techniques focus on replacing only the innermost layer of the cornea (the endothelium). DMEK and DSEK are typically used for conditions like Fuchs’ dystrophy. These procedures are less invasive and usually involve quicker recovery times compared to full-thickness transplants.
The Corneal Transplant Procedure
Step 1: Pre-Surgical Evaluation
Before surgery, a detailed eye examination is conducted to assess your condition. I will measure the thickness, shape, and overall health of your cornea to determine the best treatment plan.
Step 2: Surgery
Corneal transplant surgery typically takes 1-2 hours and can be done under local or general anesthesia depending on the patient’s needs. During the surgery:
•A circular portion of the damaged cornea is removed.
•A matching donor cornea, obtained from a healthy deceased donor, is carefully stitched into place using ultra-fine sutures.
•In partial-thickness transplants (DALK, DSEK, DMEK), only the affected layers are replaced, preserving the healthy portions of the cornea.
Step 3: Post-Surgery Care
After surgery, patients are monitored closely for any signs of infection or complications. Eye drops are prescribed to help the healing process and prevent rejection of the donor cornea. The recovery period varies based on the type of transplant, but most patients notice a significant improvement in vision within a few months.
Recovery and Healing
Recovering from corneal transplantation can take some time, and it’s essential to follow your surgeon’s advice to ensure the best outcome. Here’s what to expect:
• First Few Weeks: Your eye may be red, irritated, or sensitive to light. Eye drops will help reduce inflammation and prevent infection.
• Vision Improvement: Vision may be blurry immediately after surgery, but it will improve gradually as your eye heals. Patients undergoing partial-thickness transplants (DMEK/DSEK) often recover vision faster.
• Suture Removal: If you undergo a penetrating keratoplasty, sutures may remain in place for up to a year and are removed gradually as the cornea heals.
• Follow-Up Care: Regular follow-up appointments are essential to monitor the healing process and ensure there is no rejection of the donor cornea.
Risks and Complications
Corneal transplants, like any surgery, carry some risks. These include:
•Rejection of the Donor Cornea: In some cases, the immune system may attack the donor cornea, leading to rejection. Early symptoms include redness, pain, and vision changes. Prompt treatment with eye drops or medication can often prevent permanent damage.
•Infection or Inflammation: Infections are rare but can occur. That’s why it’s important to follow all post-surgery instructions and attend regular check-ups.
•Astigmatism: Some patients develop astigmatism due to the shape of the donor cornea. This can be corrected with glasses, contact lenses, or additional surgery.
Success Rates
Corneal transplant surgery has a high success rate. The outcome largely depends on the underlying condition and the patient’s adherence to post-surgery care. For most patients, keratoplasty can restore clear vision and improve their quality of life.
• Penetrating Keratoplasty Success: Around 90% of PK transplants are successful, with donor tissue lasting many years.
• DMEK/DSEK Success: These procedures have even higher success rates, with quicker recovery times and lower rejection risks.
Conclusion
Corneal transplantation is a powerful procedure that can restore vision and enhance the lives of those with corneal diseases. At Tandon Eye Hospital, we specialize in providing the latest advancements in keratoplasty, ensuring the best care for our patients.
If you are facing corneal issues and considering a transplant, it’s important to discuss your options with an experienced corneal specialist. I’m here to guide you through every step of the process, ensuring the best possible outcome for your vision.
Corneal Transplant Specialist, Tandon Eye Hospital
