Corneal Transplant Surgery

According to the American Academy of Ophthalmology over 40,000 corneal transplant procedures are performed each year in the United States. 

Overview of Corneal Transplants

The cornea is the transparent, dome-shaped surface on the front of your eye.  It covers your iris (colored part of your eye) and pupil.  The cornea significantly accounts for your eye’s focusing power and works together with the lens (inside your eye) to focus objects so you can see.

If your cornea becomes injured, cloudy, infected, or otherwise scarred, your eyesight may become impaired.  The first course of treatment prescribed by your eye doctor often involves medication to try to control the symptoms.   If your symptoms do not improve or your vision worsens, a corneal transplant may be necessary.

A Corneal Transplant is a surgical procedure where the corneal tissue that that is damaged or diseased is replaced by corneal tissue (from a donor).  Corneal transplantation is also referred to as corneal grafting or penetrating keratoplasty. 

The entire procedure is performed under a surgical microscope and usually takes between 1 and 2 hours.  In most cases, Corneal Transplant surgery is performed on an outpatient basis, which means you enter the hospital or surgery center a few hours prior to surgery and you return home on the same day (generally a few hours after the operation). 

Because a corneal transplant involves replacing your corneal tissue with foreign tissue, the highest risk of this procedure is rejection of the donor tissue by your immune system.  While drugs can minimize the risk of rejection of a corneal transplant, the rate of rejection varies from a range of 5% to 30% of the time (source American Academy of Ophthalmology website). 

If the cornea is rejected, another corneal transplant surgery may be performed, usually with good results, although the overall rejection rates for repeated transplants are higher than they are for the first operation. 

Irregular curvature of the transplanted cornea (astigmatism) may slow the return of vision but can also be treated. Vision may continue to improve up to a year after surgery.

Even when corneal transplant surgery is successful, if you have other existing eye conditions, like, glaucoma, macular degeneration, or diabetic retinopathy, your vision may be limited after your operation. However, even if you have these problems, a corneal transplant may still be worthwhile.

For the most successful outcome, both the patient and eye surgeon must pay particular care and attention in treatment.   For someone affected with a deeply scarred or swollen cornea, there is no other treatment that has as much to offer as a corneal transplant procedure.

What Are the Signs That Corneal Transplant Surgery May Be Necessary?

Some of the early indications for a corneal transplant include:

  • Corneal scarring (which can happen as a complication from herpes)
  • Swelling of the cornea due to an inadequate number of endothelial cells in the inner most laryer
  • Thinning of the cornea
  • Clouding of the cornea  from inadequate number of endothelial cells or chemical or physical trauma resulting in scarring
  • Central Corneal ulcers  leading to scarring that decreases vision
  • Keratoconus, a steep curving of the cornea;
  • Hereditary corneal failure (like, for example, Fuchs' dystrophy
  • Complications from a previous eye surgery, including
  • Previous corneal transplant operation where the previous donor cornea was rejected
  • Post LASIK thinning or ectasia

Do I Need a Corneal Transplant?

Corneal transplants are most often performed to help restore significant loss of vision due to a damaged, infected, or diseased cornea. 

A corneal transplant may be needed when other treatments are unsuccessful in improving your vision in a satisfactory manner with eyeglasses or contact lenses.

In other cases involving severe scarring of your cornea, where the medication prescribed by your eye doctor is unsuccessful in treating the problems with your cornea, a Corneal Transplant may be required.  This is often associated with painful swelling of your eyes that is not relieved by medications or special contact lenses and Corneal Transplant surgery can also help relieve pain and decrease other symptoms due to corneal problems.

What Is Corneal Transplant Surgery?

Corneal Transplant surgery involves replacing damaged or diseased corneal tissue with healthy new corneal tissue from a donor.  The basic types of Corneal Transplant Surgery procedures are:

Penetrating Keratoplasty. Here the entire central thickness of the cornea is transplanted.  This type of transplant is only done if the cornea has scarring or cloudiness in the central portion over the pupil.  It is no longer the most common type of corneal transplantation. This procedure takes much longer to perform and requires many sutures to secure the new donor cornea.

DSEK or DMEK.  DSEK (Descemet's Stripping Endothelial Keratoplasty) This is now the most common type of corneal transplant. It  involves removing just the innermost layers of the cornea and replacing it with a similar thin layer from a donor containing healthy endotheilial cells.  This is a much quicker and safer operation and requires a much smaller incision into the cornea and only a few sutures.

Corneal Transplant Using Femtosecond Laser.   This special laser can be used to make the cutting of the tissue more accurate and can reduce the amount of postoperative astigmatism.

Complications and Risks of Corneal Transplants

Approximately 40,000 corneal transplants are performed each year in the United States.  As with any surgical procedure, there are possible risks that serious complications may develop from a corneal transplant, such as:

  • Pain
  • Redness
  • Infection
  • Swelling of the cornea
  • Increased sensitivity to light
  • Increased risk of Cataracts (Clouding of the lens inside your eye)
  • Increased risk of Glaucoma (Pressure in Your Eye)
  • Swelling of the retina
  • Detachment of the retina
  • Vision loss

All of these complications can be treated.  In most cases problems stemming from a corneal transplant can be mitigated if not eliminated or corrected.

Rejection of the Donor Cornea.   There is also a significant risk that the donor cornea will be rejected.  According to the American Academy of Ophthalmology (AAO), 5% to 30% of all corneal transplant are rejected. When this happens the rejected cornea typically clouds and your vision deteriorates.  However, most rejections can be stopped with minimal injury provided it is treated promptly by a competent surgeon. The warning signs of rejection of the donor cornea include:

  • persistent discomfort
  • sensitivity to light
  • redness
  • pain
  • loss of vision.

If you have any of these symptoms following a corneal transplant, you should contact your eye surgeon immediately.

If the donor cornea is rejected, another corneal transplant procedure with a new donor cornea will typically/usually need to be performed…

Insurance Coverage

In general, most health insurance plans cover corneal transplant surgery. If you are planning to have this procedure, we recommend you contact your health insurance company and ask if there are any requirements you need to meet before having surgery to ensure you are covered.  In addition, you should ask what costs are covered, including post-operative care such as follow up visits with your eye doctor.

Do You Need To Find a Corneal Transplant Surgeon?

If you need a corneal transplant operation, Trusted LASIK Surgeons strongly recommends you find a fellowship trained corneal expert.

Many of the LASIK, refractive, and cataract surgeons listed at Trusted LASIK Surgeons have proven experience in performing corneal transplants and many of these corneal surgeons have made contributions to this field through their research and by teaching other surgeons to perform this operation.  Plus, since these surgeons offer a range of refractive surgery procedures, they typically offer you complete refractive care to give you a wide range of options to improve your vision. 

Those refractive specialists featured at Trusted LASIK Surgeons who perform Corneal Transplant Surgery typically have proven experience and most have been professionally recognized for their expertise and contributions in this specialized surgical field

If you think you need a corneal transplant, please visit our LASIK Directory and contact a surgeon closest to you.  Even if that surgeon does not perform corneal transplants, he or she should be able to refer you to a proven expert who does perform this procedure and many of our surgeons who worked with donor eye banks in their local community. 

You are also welcome to contact us directly and we will do our best to help you find an experienced corneal surgeon who can help you.

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