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ADULT CORNEAL TRANSPLANTATION
CORNEAL TRANSPLANTS
The cornea is the clear front of the eye that covers the colored
iris and the round pupil. Light is focused as it passes through
the cornea and the lens to the retina, and then to the brain, enabling
sight. If the cornea becomes damaged by swelling or scarring, its
smoothness and clarity of vision can be lost. Cornea transplants
are the only option currently available for people who have scarring
in the center of their corneas, or who cannot tolerate hard contact
lenses because their corneas are too steep as a result of keratoconus.
In a cornea transplant, healthy tissue is taken from a recently
deceased organ donor and surgically implanted in the eye of the
recipient in order to repair eye damage. This type of transplant
is the most successful of all organ transplants, with a success
rate of 96 to 98 percent. Over 40,000 corneal transplants are performed
each year in the United States by ophthalmologists.
INDICATIONS
Corneal transplantation may be indicated for the following reasons:
| 1. |
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To improve vision
by replacing a damaged cornea with clear, healthy donor tissue |
| 2. |
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To preserve corneal
anatomy and integrity, or to reconstruct the anatomy of a damaged
eye |
| 3. |
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To correct damage
caused by another eye surgery, such as cataract surgery |
| 4. |
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To remove inflamed
tissue that does not respond to treatment by antibiotics or
antiviral medications |
| 5. |
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Keratoconus (steep,
outward curving of the cornea) |
| 6. |
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Failure of the
cornea due to hereditary factors, such as Fuch’s cornea |
| 7. |
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Scarring caused
by infection, including herpes, or an injury |
| 8. |
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Rejection after
a first corneal transplant |
| 9. |
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To improve the appearance of
patients with corneal scars that make the cornea appear whitish
or opaque |
THE PROCEDURE
Once the decision has been made by the patient and their ophthalmologist
to have a corneal transplant, the patient’s name is put on a list
at the local eye bank. The waiting period is usually short. When
a donated cornea becomes available, the donor is first checked for
hepatitis and AIDS. The cornea itself is also checked to make sure
it is not damaged.
This painless surgery is usually performed on an outpatient basis,
and either a local or general anesthesia will be given. During the
surgery, the patient’s damaged cornea is gently removed and any
other damage repaired. The new cornea is then stitched into place.
Outpatients are allowed to go home the same day after spending a
short period of time in the recovery room, but someone else should
do the driving. There will be a follow-up examination the day after
surgery. Vision will be blurry for approximately 3 to 6 months after
the surgery. The doctor will start removing the sutures in 3 months,
and it will take approximately 6 months before they are completely
removed. Anti-rejection and antibiotic drops must be applied four
times a day.
At the end of the 6-month period after the surgery, most people
will have some nearsightedness and astigmatism, which can be corrected
with hard contact lenses or glasses. However, additional procedures
such as astigmatic keratotomy or LASIK can be used to eliminate
the need for contacts or glasses.
LAMELLAR CORNEA TRANSPLANTS
People who have damage in the front (anterior) part of the cornea
are good candidates for lamellar corneal transplants. This might
include people who have had complications from LASIK surgery. During
this type of transplant surgery, only one-third of the front portion
of the cornea is transplanted. The rate of rejection in this type
of transplant is quite low, and if it does occur, another lamellar
transplant can be performed at no additional risk.
This type of transplant surgery requires a tremendous amount of
skill and specialized equipment. The physicians at Cedars-Sinai
Medical Center have the most sophisticated equipment available to
perform these complex procedures.
SELF-CARE AFTER CORNEAL
TRANSPLANT
People who receive a cornea transplant will need to:
1. Use eye drops as prescribed
2. Be careful not to rub or press their eye
3. Use over-the-counter pain medication, when needed
4. Continue their normal activities, except exercise
5. Ask the doctor when they can begin driving again
6. Wear an eye shield or glasses, as prescribed by the doctor
RISKS
Corneal transplants are rejected 5 to 30 percent of the time. The
rejected cornea becomes cloudy and vision deteriorates. Common warning
signs of rejection include:
1. Persistent discomfort
2. Light sensitivity
3. Redness
4. Change in vision
Other possible complications include:
1. Infection
2. Bleeding
3. Swelling or detachment of the retina
4. Glaucoma
These complications can be treated successfully if they are reported
to the ophthalmologist promptly.
In the case of rejection that cannot be treated successfully, another
transplant can be performed, usually with good results. However,
repeat transplants have a higher rate of rejection than the first
transplant.
A successful corneal transplant requires careful consideration by
both the patient and physician. However, no other surgery has so
much to offer when the cornea is deeply scarred or swollen. Most
of the people who receive a corneal transplant are satisfied with
their improved vision. Of course, this transplant surgery would
not be possible without the thousands of generous donors and their
families who have donated corneal tissue so that others can see.
RESEARCH
Our ongoing research will ultimately lead to improved treatments
and possibly even a cure for eye disease, thereby eliminating the
need for corneal transplants in many cases. Support from the public
and private donor funding is needed to continue these ongoing research
efforts. If you are interested in participating or would like to
learn more about how you can become involved, please contact Donna
Kronson at:
dkronson@eyedefectsresearch.org
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