Corneal transplant surgery, also called keratoplasty, involves removing the central area of a patient's cornea and replacing it with a donor's cornea. The surgery only takes place when the best corresponding donor tissue is found. This can take weeks or months. A cornea transplant can restore vision, reduce pain and improve the appearance of a damaged or diseased cornea. A cornea transplant can treat a number of conditions. These include: thinning of the cornea, cornea scarring (caused by infection or injury), clouding of the cornea, swelling of the cornea, corneal ulcers and complications caused by previous eye surgery.
The surgery is a same-day procedure that takes between one and two hours. Before surgery, the patient is given a light intravenous sedative and the eye is anesthetized. A trephine (a circular cutting device) is placed over the cornea and is used by the surgeon to cut the host cornea, which removes a circular disc of the patient cornea. The trephine is then removed and the surgeon cuts a circular graft (a "button") from the donor cornea. Once this is done, the surgeon returns to the patient's eye and removes the host cornea. The donor cornea is then brought into the surgical field and maneuvered into place with forceps. Once in place, the surgeon will fasten the cornea to the eye with stitches. Antibiotic eye drops are placed, the eye is patched, and the patient is taken to a recovery area while the effects of the anesthesia wear off. The patient typically goes home following this and sees the doctor the following day for the first post-operative appointment.
An eye patch and shield are used to protect the eye after surgery, but removed the next day at the post-operative appointment. This shield is used at night to protect the eye from rubbing. Most patients are asked to limit strenuous physical activities until healing has occurred. Subsequent clinic visits are scheduled to assess healing and remove the sutures. Recovery is longer than with other eye surgeries, often taking one or two years to obtain good vision. Most people who receive a cornea transplant will have their vision at least partially restored, but what you can expect depends on the reason for your surgery and your health conditions.
In most instances, the patient will meet with their ophthalmologist for an examination in the weeks or months preceding the surgery. During the exam, the ophthalmologist will examine the eye and diagnose the condition. The doctor will then discuss the condition with the patient, including the different treatment options available. The doctor will also discuss the risks and benefits of the various options.
Your risk of complications and cornea rejection continues for years after your cornea transplant. For this reason, expect to see your eye doctor annually. Cornea rejection can often be managed with medications.
Once the outer layer of your cornea has healed — several weeks to several months after surgery — your eye doctor will work to make adjustments that can improve your vision, such as:
- Correcting unevenness in your cornea (astigmatism). The stitches that hold the donor cornea in place on your eye may cause dips and bumps in your cornea, making your vision blurry in spots. Your doctor may correct some of this by releasing some stitches.
- Correcting vision problems. Refractive errors, such as nearsightedness and farsightedness, can be corrected with glasses, contact lenses or, in some cases, laser eye surgery.