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Corneal Transplants

 

New windows for sight

Ophthalmologists (medical eye doctors) perform over 40,000 corneal transplants each year in the United States. Of all transplant surgery done today including hearts, lungs and kidneys, corneal transplants are by far the most common and successful.

What is the cornea?

The cornea is the clear front of the eye that covers the colored iris and the round pupil. Light is focused while passing through the cornea so we can see. To stay clear the cornea must be healthy.

How can an unhealthy cornea affect vision?

If the cornea is damaged it may become swollen or scarred. In either case, its smoothness and clarity may be lost. The scars, swelling or an irregular shape cause the cornea to scatter or distort light, resulting in glare or blurred vision.

A corneal transplant is needed if:

  • Vision cannot be corrected satisfactorily;
  • Painful swelling cannot be relieved by medications or special contact lenses.

What conditions may require corneal transplants?

  • Corneal failure after other eye surgery, such as cataract surgery;
  • Keratoconus, a steep curving of the cornea;
  • Hereditary corneal failure, such as Fuch's cornea;
  • Scarring after infections, especially after herpes;
  • Rejection after first corneal transplant;
  • Scarring after injury.
  • Complications from LASIK (lamellar transplants).

What happens if you decide to have a corneal transplant?

Before surgery

Once you and your ophthalmologist decide you need a corneal transplant, your name is put on a list at the local eye bank. Usually the wait is short.

Before a cornea is released for transplant, the eye bank tests the human donor for the viruses that cause hepatitis and AIDS. The cornea is carefully checked for clarity.

Your ophthalmologist may request that you have a physical examination and other special tests. If you usually take medications, ask your ophthalmologist if you should continue them.

The day of surgery

Surgery is often done on an outpatient basis. You may be asked to skip breakfast, depending on the time of your surgery. Once you arrive for surgery, you will be given eye drops and sometimes medications to help you relax.

The operation is painless. Anesthesia is either local or general, depending on your age, medical condition and eye disease. You will not see the surgery while it is happening, and will not have to worry about keeping your eye open or closed.

The operation

The eyelids are gently opened. Looking through a surgical microscope, the ophthalmologist measures the eye for the size for the corneal transplant.

The diseased or injured cornea is carefully removed from the eye. Any necessary additional work within the eye, such as removal of a cataract, is completed. Then the clear donor cornea is sewn into place.

When the operation is over, the ophthalmologist will usually place a shield over your eye.

After surgery

If you are an outpatient, you may go home after a short stay in the recovery area. You should plan to have someone else drive you home. An examination at the doctor's office will be scheduled for the following day.

You will need to:

  • Use the eye drops as prescribed;
  • Be careful not to rub or press on your eye;
  • Use over-the-counter pain medicine, if necessary;
  • Continue normal daily activities except exercise;
  • Ask your doctor when you can begin driving;
  • Wear eyeglasses or an eye shield as advised by your doctor.

Your ophthalmologist will decide when to remove the stitches, depending upon the health of the eye and rate of healing.

Usually, it will be several months, at least, before stitches are removed.

What can I expect after transplant surgery?

Cornea Transplants are done on an outpatient basis. The procedure itself takes 45 minutes to 75 minutes depending on the complexity of the situation. You should expect to spend the whole morning at the outpatient surgery center however.

When you leave the hospital you will wear a patch and a shield. This will be removed the next day at your follow up visit at the doctor's office. After that you will be wearing dark glasses during the day and a protective shield at night only. Your vision will be blurry for approximately 3 - 6 months.

At 3 months you will start having your sutures removed and they should all be removed by the end of 6 months a little longer if you are older. At the end of 6 months you will be fitted with glasses or contact lenses. During the whole 6-month period you will take anti -rejection drops and antibiotic drops approximately 4 times a day.

For the first 6 weeks heavy exercise and lifting of heavy objects will be prohibited but otherwise you can live a normal life. Most people return to work 3-7 days after their surgery depending on the type of work they do.

Corneal transplants are rejected 5% to 30% of the time. The rejected cornea clouds and vision deteriorates.

Can I get rid of contacts or glasses after transplant surgery?

Yes it is possible to be free of contact lenses or glasses after transplant surgery. This will however require additional procedures such as astigmatic keratotomy or LASIK. The fees for these procedures are not included in the cost of the original procedure and may not be covered by traditional insurance, though under certain circumstances they may be covered.

After all the sutures are removed most patients are left with a certain amount of nearsightedness and astigmatism. This can be corrected either with Rigid contact lenses or glasses.

If the astigmatism is large this can be corrected with astigmatic keratotomy to bring the patient to less than 4D of astigmatism. Patients with less than 4D of astigmatism and less than 8D of myopia can then have their vision corrected with LASIK.

We have many patients who have successfully undergone these procedures and some of them would be happy to talk to you about their experiences.

Lamellar cornea transplants - advantages and candidates

Individuals whose disease is in the anterior portion of the cornea, such as patients who have had complications from LASIK surgery or who have certain corneal dystrophies, are excellent candidates for lamellar corneal transplants.

A lamellar cornea transplant is another name for a partial thickness cornea transplant ie. is only one third of anterior portion the patient's cornea is transplanted. This has many advantages over a normal cornea transplant in that the rate of rejection is almost negligible and if it does reject it can easily be replaced with another lamellar transplant with almost no additional risk to the patient.

Performing such a transplant however requires a teremendous amount of skill and very specialized equipment. We have the most sophisticated equipment at Cedars-Sinai Medical Center specifically to perform these complex procedures.

An added advantage of the lamellar transplant is that they button can be lifted at a later date and the patients' residual refractive error can then be corrected with an excimer laser procedure at very little additional risk to the patient.

Who is best qualified to do a cornea transplant?

The person most qualified to do a cornea transplant is an ophthalmologist fellowship trained in cornea transplant surgery. Most excellent transplant surgeons who have an academic interest in the advancement of knowledge on cornea transplantation are also members of the Castroviejo Cornea Society. For further information on Yaron S. Rabinowitz M.D, fellowship trained cornea transplant surgeon and member of the Castroviejo cornea society for the past 10 years, please click here.

Out of state patients - accommodations and resources

We routinely have patients fly in from different parts of the world to have their transplant surgery done at Cedars-Sinai Medical Center. They know that it is worth their while to come here because they are going to receive the very best care possible.

In order to help our patients we have arranged a special accomodation rate at a hotel within walking distance both from our office and our outpatient surgery center. The name of the Hotel is the Beverly Plaza Hotel and the negotiated rate is $135 dollars per night. To find out more about the hotel click on their web address at www.beverlyplazahotel.com

For those who do not have a good command of the engllish language we have translators available in every possible language. If you need to make use of this service please let us know in advance so we can have these services Available for you when you arrive at our office.

What complications can occur?

Corneal transplants are rejected 5% to 30% of the time. The rejected cornea clouds and vision deteriorates.

Most rejections, if treated promptly, can be stopped with minimal injury. Warning signs of rejection are:

  • Persistent discomfort;
  • Light sensitivity;
  • Redness;
  • Change in vision.

Any of these symptoms should be reported to your ophthalmologist promptly.

Other possible complications include:

  • Infection;
  • Bleeding;
  • Swelling or detachment of the retina;
  • Glaucoma.

All of these complications can be treated.

A corneal transplant can be repeated, usually with good results, but the overall rejection rates for repeated transplants are higher than for the first time around.

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 if the surgery is successful, any other eye conditions, such as macular degeneration (aging of the retina), glaucoma or diabetic damage may limit vision after surgery. Even with such problems, corneal transplantation may still be worthwhile.

A successful corneal transplant requires care and attention on the part of both patient and physician. However, no other surgery has so much to offer when the cornea is deeply scarred or swollen. The vast majority of people who undergo corneal transplants are happy with their improved vision.

Of course, corneal transplant surgery would not be possible without the hundreds of thousands of generous donors and their families who have donated corneal tissue so that others may see.

If you are a candidate for a corneal transplant and would like to receive a more detailed booklet about corneal transplants please mail us a $20 donation made out to the Eye Birth Defects Research Foundation with your return adress. To find out more about the Eye Birth Defects Research Foundation click on the link on the left side of this page.

Telephone: 310-423-9640
Fax: 310-423-9649
Email: rabinowitzy@cshs.org

Last modified: 01/23/08 12:00:00 PM