Corneal transplant surgery involves the removal of a patient’s diseased or damaged cornea and replacing it with a healthy donor cornea. The cornea is the clear element at the front of the human eye, which begins to refract (focus) incoming light and pass it through to the inner eye. When the cornea becomes misshapen, cloudy, scarred or otherwise damaged, there are a variety of treatments available. An ophthalmologist resorts to a corneal transplant when other methods of treatment have been exhausted. The corneal transplant is the most commonly performed, and most successful, of all transplant surgeries.
Reasons for considering a corneal transplant:
Complications from other eye surgery resulting in failure of the cornea.
Dystrophy of the cornea such as Fuchs'.
Eye trauma resulting in corneal scarring.
Hereditary problems with the cornea.
Keratoconus, a disease in which the cornea degenerates into a steep cone shape.
Rejection of a previous corneal transplant.
Various corneal infections that lead to scarring, including herpes viruses.
Doctors usually prefer to exhaust other, non-invasive forms of treatment first. However, when problems of vision and/or pain can no longer be treated with glasses, contacts, pharmaceuticals or other specialized treatments, corneal transplant surgery is a viable solution.
Once the decision is made to undergo corneal transplant surgery, a suitable donor cornea must be obtained. This is done through an eye bank. Each potential donor is carefully screened, both for diseases that could be transmitted and for clarity. The surgery is usually an outpatient procedure. In preparation the doctor may choose either a local or general anesthetic, whichever is most appropriate for the patient. A speculum is used to hold the eye open.
The surgeon uses a microkreatome and a trephine (circular) blade to extract the host cornea. This may involve harvesting all or some of the layers of the donor cornea. A similar portion of tissue is cut from the donor cornea, and placed in the host eye. This is then sutured with extremely thin stitching or secured in place with an air bubble without sutures. The doctor administers antibiotic eye drops, then a patch over the eye. The procedure have different names such as penetrating keratoplasty, deep lamellar keratoplasty, DSAEK or DMEK.
The patient is advised to rest the day of the surgery. There will be a post-operative appointment with the doctor the next day. After this, the patient may resume gentle tasks and activities, but must wear glasses or a shield to protect the eye, and administer eye drops as instructed by the physician. After a week, more strenuous activities (like exercise) may be carefully resumed. The stitches may be left in the eye anywhere from a few months to a year or longer. The patient must continue to remain vigilant for signs of complication, and contact the eye doctor immediately upon any abnormal occurrence.
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