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Long-term success of cornea transplant depends on the cause of the cornea damage, surgical technique used, expertise of the surgeon, chance of organ rejection and other factors.
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.
A cornea transplant is most often used to restore vision to 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.
A number of conditions can be treated with a cornea transplant, including:
Cornea transplant is a relatively safe procedure. Still, it does carry a small risk of serious complications, such as:
In some cases, your body’s immune system may mistakenly attack the donor cornea. This is called rejection, and it may require medical treatment or another cornea transplant.
Make an appointment with your eye doctor if you notice any signs and symptoms of rejection, such as:
Rejection occurs in about 10 percent of cornea transplants.
Before cornea transplant surgery, you will undergo:
Your doctor will discuss what to expect during the procedure and explain the risks of the procedure.
Most corneas used in cornea transplants come from deceased donors. Unlike with organs such as livers and kidneys, people needing cornea transplants generally will not need to endure long waits. That’s because many people specifically request that their corneas be available for donation after they die, unless they have had certain conditions, so more corneas are available for transplantation.
Corneas may not be used from donors who had several conditions, such as certain central nervous system conditions, infections, and prior eye surgery or eye conditions, or from people who died from an unknown cause.
On the day of your cornea transplant, you’ll be given a sedative to help you relax and a local anesthetic to numb your eye. You won’t be asleep during the surgery, but you shouldn’t feel any pain.
During the most common type of cornea transplant (penetrating keratoplasty), your surgeon cuts through the entire thickness of the abnormal or diseased cornea to remove a small button-sized disk of corneal tissue. An instrument that acts like a cookie cutter (trephine) is used to make this precise circular cut.
The donor cornea, cut to fit, is placed in the opening. Your surgeon then uses a fine thread to stitch the new cornea into place. The stitches may be removed at a later visit when you see your eye doctor.
In some cases, if people aren’t eligible for a cornea transplant from a donor cornea, doctors may insert an artificial cornea (keratoprosthesis).
With some types of cornea problems, a full-thickness cornea transplant isn’t always the most appropriate treatment. Other types of transplants may be used that remove only certain layers of cornea tissue, or only tissue affected by disease. These types of procedures include:
Once your cornea transplant is completed, you can expect to:
Most people who receive a cornea transplant will have their vision at least partially restored. What you can expect after your cornea transplant depends on the reason for your surgery and your health.
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.
Your vision may initially be worse than before your surgery as your eye adjusts to the new cornea. It may take several months for your vision to improve.
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:
You will be in the operating room for 1-2 hours, but the actual surgery will take less time.
Following surgery, your eye most likely will be red, irritated, and sensitive to light. You may experience increased tearing and a slight discharge. Discomfort usually is controlled with Tylenol or another brand of acetaminophen during the first few days after surgery.
Your eye will be covered with a patch and a metal shield the day of surgery. Your glasses may not fit over the patch and shield. Your surgeon most likely will remove the patch and shield at your follow-up appointment the next day. You must wear the shield over your eye while sleeping for some time after surgery.
Most people will have sutures, although you probably will not be aware of them. Some sutures may be removed as early as one month after surgery. Others may remain for years.
You will need to use eye drops and sometimes eye ointment to quiet inflammation and prevent graft rejection.
Your nurse and surgeon will talk to you about activity restrictions. You should avoid any activities that could involve a direct blow to the eye, such as contact sports.
Vision usually is blurred after surgery. It gradually improves as healing takes place. As the eye heals and the sutures are removed, the shape of the cornea changes. Therefore, your surgeon usually will wait between 3 and 12 months before prescribing a new lens for your glasses. If needed, a contact lens may be prescribed.
If the vision in your other eye is adequate for driving, you may drive after the anesthetic has completely worn off. This may take up to 24 hours. Your surgeon may recommend you wait several days before driving. Remember, you must have someone to drive you home from the hospital as well as someone to bring you back the next day for your follow-up visit.
The risk of corneal transplant rejection is low. However, it is possible to have a rejection at any time – even many years after your transplant surgery – and it is important to know the signs of rejection. A corneal transplant can be repeated, usually with good results. However, the overall rejection rates for repeated transplants are slightly higher than for the first transplant.
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