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What is the cornea?

The cornea is the curved, clear front covering of your eye. A healthy cornea helps focus light rays on your retina so you have sharp vision. A cornea damaged by swelling or scarring scatters the light rays, resulting in glare or blurred vision. Most of the time eyeglasses or contacts can fix vision problems caused by corneal disease. A corneal transplant may be necessary if your vision cannot by corrected by glasses or if you are experiencing painful swelling that cannot be relieved by medication.

What conditions may require corneal transplants?

There are several conditions that may lead to a corneal transplant. These include hereditary corneal failure such as Fuchs' Dystrophy; corneal failure after another eye surgery such as cataract surgery; scarring after injury; keratoconus, a steep curving of the cornea; scarring caused by viral or bacterial infection; or rejection after first corneal transplant.

What is a Corneal Transplant?

Corneal transplants are one of the most common and successful transplants performed today. Ophthalmologists in the U.S. perform 35-40,000 procedures each year. A transplant requires a donor cornea arranged through the local eye bank. Fortunately, the typical wait for a donor cornea is not very long. The eye bank will check the donated cornea very carefully for clarity, healthy cells and for the viruses that cause hepatitis and AIDS.

The Transplant

Corneal transplants are performed at an outpatient facility using either local or general anesthesia, depending on your age, medical condition and eye disease. Three types of transplants are performed.  DSEK (Descemet's Stripping Endothelial Keratoplasty) or sutureless transplant is the most common type and the procedure of choice for Fuchs' corneal dystrophy.  The depleted inner layer of cells is replaced with healthy donor cells on a thin layer of posterior cornea.  The normal outer cornea is left in place.  If the outer layer of the cornea is cloudy or damaged then an Anterior Lamellar Transplant (ALK) is performed.  The healthy inner portion of the cornea is retained.  This is done for superficial corneal scars and for Keratoconus.  If the cornea is cloudy throughout, then full thickness transplants are done.  The last two types of transplants require sutures and have a slower recovery.  If you have a cataract, that may be removed at the same time. A patch is worn the first night and a shield will be placed over your eye to protect it during the recovery period.

How successful are corneal transplants?

It is important to understand that the recovery of your cornea to good vision is variable according to the type of transplant performed.  DSEK heals quickly with functional vision returning in 6-8 weeks.  Vision can continue to improve over the next 1-2 years.  Sutured transplants heal slower with recovery of functional vision taking 9-12 months.  The risk of a cornea rejection is between 5-10% on initial transplants.  If you experience a rejection, a transplant can be repeated often with good results. Artificial corneas are also available for patients who reject multiple transplants.

The decision to have a corneal transplant is a significant one. The transplant and recovery requires special care by the patient and physician.  Most people have considerable success with the procedure and are enjoying better vision today because of it.  Your surgeon will explain all of your treatment options, risks and benefits so you can make an informed decision about your corneal transplant.

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