Corneal transplant

Corneal transplant

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Corneal transplant

Corneal transplant
Corneal transplant

Corneal transplant

Columbia Asia Hospital Pune is offering corneal transplant as a part of its ophthalmological services. The multispecialty hospital offers the services of associated

What is a corneal transplant?

A corneal transplant, also known as keratoplasty is a surgical procedure to replace part of a cornea with healthy corneal tissue from a donor.

A cornea transplant can restore vision, reduce pain and improve the appearance of a damaged or diseased cornea. Most cornea transplant procedures are successful. But cornea transplant carries a small risk of complications, such as rejection of the donor cornea.

What is the cornea?

The cornea is the transparent, dome-shaped surface of the eye that accounts for a large part of the eye's focusing power. The cornea also covers both the iris (the coloured portion of the external eye) and the pupil. There are no blood vessels in the cornea, but there are nerves. Nutrients for the cornea are supplied by the same source as the tear-ducts and internal eye fluids.

Indications for corneal transplant

A cornea transplant is most often used to restore vision of a person who has a damaged cornea. A cornea transplant may also relieve pain or other signs and symptoms associated with diseases of the cornea.

At Columbia Asia Hospitals, we offer interventional cardiology treatment options. Our cardiologists are trained in premier institutions in India and abroad and periodically update their skills to practice contemporary medicine. Evidence based medicine and following international treatment protocols is the hallmark of the department.

Diseases for which corneal transplant is done

  • Keratoconus (when the cornea bulges outward)
  • Fuchs' dystrophy (when innermost layer of corneal tissue degenerates)
  • Thinning of the cornea
  • Corneal scarring, caused by infection or injury
  • Eye herpes or fungal keratitis
  • Scarring from trichiasis, when eyelashes grow inwardly
  • Clouding of the cornea
  • Swelling of the cornea
  • Corneal ulcers, including those caused by infection
  • Corneal damage caused by previous eye surgery

Preparation for the corneal transplant

Before the corneal transplant surgery, the patient undergoes:

  • A thorough general examination for other associated diseases like diabetes, hypertension etc
  • A thorough eye examination of the vision including fundal examination. 
  • Measurements of the eye to estimate what size donor cornea is needed.
  • A review of all medications and supplements taken regularly. One may need to stop taking certain medications like blood thinners or supplements before or after the cornea transplant.
  • Treatment for other unrelated eye problems, such as infection or inflammation

Finding the donor Cornea

Corneas used in corneal transplants come from deceased donors. Corneas may not be used from donors who had central nervous system conditions, infections, and prior eye surgery or eye conditions, or from people who died from an unknown cause.

Types of Keratoplasty

Full Thickness Corneal Transplant (penetrating keratoplasty)

This is done when both the front and inner corneal layers are damaged and replaced with the donor cornea. The recovery period is longer and return of complete vision may take a year or two or longer. There is a higher chance of rejection in this method. This procedure is indicated if there is a severe cornea injury or bad bulging and scarring.

Partial Thickness Corneal Transplant/ Deep Anterior Lamellar Keratoplasty (DALK)

This method is done if the front and middle layers of the cornea are damaged. The surgeon injects air to lift off and separate the thin outside and thick middle layers of the cornea, then removes and replaces only those. People with keratoconus or a corneal scar that hasn't affected the inner layers may have this done.

The healing time with this procedure is shorter than a full thickness transplant. Because the eye itself isn't opened up, it's unlikely the lens and iris could be damaged, and there's less chance of an infection inside the eye.

Endothelial Keratoplasty

This method is done when the innermost layer of the cornea, the endothelium is damaged.

What to expect on the day of the surgery

  • Eye drops will be put in the eyes
  • A sedative will be given
  • A local anaesthetic is given to numb the eye.
  • The eye will be kept open with an instrument
  • In some cases, a small button-sized disc of diseased corneal tissue is removed.
  • The donor cornea, cut to fit, is placed in the opening and a fine thread is used to stitch the new cornea into place.
  • The surgery will take approximately one to two hours

After the corneal transplant

Once the cornea transplant is completed, patient is given:

  • Several medications. Eye drops and, occasionally, oral medications immediately after cornea transplant and continuing during recovery will help control infection, swelling and pain.
  • An eye patch. An eye patch may protect the eye as it heals after surgery.
  • After the patch is removed, it is important to protect the eye from accidental bumps or pokes. Typically, for several months after surgery, patients wear glasses during the day and a plastic shield at night to protect the eye from trauma while sleeping. Since the new cornea is delicately sutured in place, a direct blow to the eye must be avoided. Contact sports are discouraged after corneal transplant. Otherwise, normal activity can be resumed within a few days. After the first day, shaving, brushing teeth, bathing, light housework, bending over, walking, reading, and watching TV will not hurt the eye.
  • Because the cornea has no blood supply, the transplant heals relatively slowly. Sutures are left in place for three months to one year, and in some cases if the vision is good, they are left in permanently. The sutures are buried and therefore don’t cause discomfort. Occasionally, they do break and then need to be removed. to improve vision.
  • Suture adjustment and removal to improve vision.

The sutures used in corneal transplants are made of a monofilament nylon and are quite small (22 microns – 1/3 the thickness of a human hair).

Vision gradually improves as the new cornea heals. There is often useful vision within a few weeks. However, in some cases, it may take several months to a year for good visual acuity.

To prevent rejection of the new cornea, steroid eye drops are used for several months after surgery. In some cases, low dosage steroid drops are continued indefinitely. Unlike oral steroids, steroid eye drops cause no side effects elsewhere in the body. Occasionally, other eye medications are necessary. There is every reason to believe the graft will succeed and last a lifetime. With proper care and prompt attention to any signs of rejection the graft will remain clear and healthy.

Postoperative care is extremely important and by far the most time-consuming part of having a corneal transplant. The eye is checked the day after surgery, several times in the first two weeks, at gradually longer intervals over the first year, and usually yearly thereafter.

Risks

Cornea transplant is a relatively safe procedure. Still, a cornea transplant does carry a small risk of serious complications, such as:

  • Eye infection
  • Increased risk of clouding of the eye's lens (cataracts)
  • Pressure increase within the eyeball (glaucoma)
  • Problems with the stitches used to secure the donor cornea
  • Rejection of the donor cornea
  • Swelling of the cornea

Signs and symptoms of corneal rejection

In some cases, the body's immune system may mistakenly attack the donor cornea. This is called rejection, and it may require medical treatment or another cornea transplant.

Signs and symptoms of rejection include:

  • Loss of vision
  • Pain
  • Redness
  • Sensitivity to light
  • Rejection occurs in about 20 percent of cornea transplants

Outcome

Most people who receive a cornea transplant will have their vision at least partially restored. The outcome depends on the reason for the transplant the general health of the patient

The risk of complications and cornea rejection continues for years after the cornea transplant. For this reason, expect to see the eye doctor annually. Cornea rejection can often be managed with medications. Stitches are removed 3 to 17 months of surgery in phases. Vision correction after the surgery: vision may initially be worse than before surgery as the eye adjusts to the new cornea. It may take several months for the vision to improve.

Once the outer layer of the cornea has healed — several weeks to several months after surgery — the eye doctor will work to make adjustments that can improve vision, such as:

  • Correcting unevenness in the cornea (astigmatism). The stitches that hold the donor cornea in place may cause dips and bumps in the cornea, making vision blurry in spots. The doctor may correct some of this by releasing some stitches and tightening others.
  • Correcting vision problems. Refractive errors, such as near sightedness and farsightedness, can be corrected with glasses, contact lenses or, in some cases, laser eye surgery.
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Corneal transplant