Eye Conditions-Corneal Transplants & Eye Surgery
Each year in the United States, there are approximately 52,000 corneal transplants performed to restore vision and comfort to patients with corneal eye diseases such as Fuchs’ corneal dystrophy, keratoconus, corneal scarring, previous transplants that have failed, herpes keratitis, and infections, among others.
Since the techniques, risks and complications are not commonly seen in general ophthalmology, most surgeons who transplant corneas have additional training in corneal surgery. Dr. Smith is one of these subspecialty-trained surgeons, performing more corneal transplants than any other eye surgeon or eye doctor in Wake County.
What to Expect After Corneal Eye Surgery
During the corneal transplant, the central cloudy cornea is removed, and a donor is sutured (stitched) into its place, using nylon thread that is the thickness of human hair. The nylon sutures remain in place for at least a year, and the healing is prolonged by the cornea’s lack of blood vessels as well as by the routine use of steroids after eye surgery to prevent rejection.
The transplant may be done by itself, or combined with another eye surgery on the lens (a cataract), the iris, or the vitreous.
In Dr. Smith’s ophthalmology practice patients are usually placed under general anesthesia for the eye surgery. The preparation of the eye for eye surgery involves the use of the same antiseptic technique used in cataract surgery. After the patient is asleep, the transplant takes 45 minutes, with additional time for another eye surgery factored into the transplant. The procedure is done on an outpatient basis, and the patient spends 4 to 5 hours total in the outpatient department.
After the eye surgery, the eye is patched in order to protect it overnight. After your eye surgery, your eye may feel scratchy, but most patients rarely need more than Tylenol. The patch is removed the following day, and a written schedule of eye medications is provided.
Corneal Transplant Surgery FAQ
Where does the tissue come from for the eye surgery?
Corneal tissue is donated by the families of the recently deceased, and it is used within 5 days of procurement. The NC Eye Bank, one of the oldest in the United States, is a meticulous and reliable source of this tissue, which is screened for HIV, hepatitis, cytomegalovirus, previous eye surgery, and other conditions as mandated by the Eye Bank Association of America. If your surgery is scheduled ahead (usually for patients 50 years and older), then you have priority for tissue. Younger patients may have to wait for suitably younger tissue, though this is rarely longer than 6 weeks.
Will my eye color change?
The corneal tissue is clear. Your own eye color will show through.
Is the tissue matched like hearts and kidneys?
Studies show that tissue typing probably does not improve the chance of rejection. The role of blood group typing on increasing corneal transplant success is currently under investigation.
What are the possible complications?
Infection is a concern for approximately 1 in 5000 cases. Wound leakage may occur in up to 5% of cases the first week after surgery and may require extra visits in order to monitor it. Corneal transplant rejection overall is about 10%, lower for keratoconus, higher for other diseases, highest for children (up to 50%). Rejection can happen at any time after this type of eye surgery, so it is important to be aware that persistent symptoms in the operated eye may give cause for concern. Rejection can be reversed if treated timely, usually with steroid drops.
When does the vision improve?
The vision from this type of eye surgery is slower to improve than that of a cataract surgery since the entire front surface of the eye has been exchanged. The first change in spectacles is not given for 2-3 months and is changed 2-3 times in the first post-op year. The prescription can change after the nylon suture is removed. If there is unacceptable residual postoperative astigmatism, refractive surgery can improve it.
Corneal transplants require significantly more work and commitment on the part of the patient and doctor. There are few remaining options if it is found that the cornea is the source of the blurred vision.