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Ophthalmology ; — Download references. You can also search for this author in PubMed Google Scholar. Close follow-up by the surgeon and his or her staff is very important. It can mean the difference between finishing up with a good result or a bad result. Ensuring that the supervision is adequate after surgery is the responsibility of the patient and the surgeon. Usually, patients with corneal grafts need to be seen on the day after surgery, then after a week, and again 4 weeks after surgery.
Later they need to be seen at 3 months, 9 months and 12 months after surgery. At the 12 month visit, the stitches are sometimes removed. Following surgery patients are given two different eye drops. One drop is an antibiotic and needs to be used 4 times a day for the first 1 - 2 weeks after surgery.
The second is an anti-inflammatory agent and needs to be used 4 times a day for the first 3 months after surgery. After 3 months the frequency can be reduced, but most patients will require one or two drops a day for at least a year. Patients usually need to wear spectacles to gain the very best vision. Whether a patient will need spectacles or contact lens is usually not decided until the stitches are removed, which is not usually for 12 months after surgery. In the meantime, spectacles may be prescribed to help in the short term.
Occasionally neither spectacles nor contact lenses will provide the level of vision required because there is excessive astigmatism. In these cases a relatively minor operation may need to be carried out to reduce astigmatism. This operation is usually referred to as "relaxing incisions" and can be carried out under local anaesthetic on a day case basis. However, after 12 months you will probably only need to be seen once a year.
It is important to remember that although you can expect to achieve good vision after surgery, your graft will remain vulnerable for many years. Should your eye ever become red or inflamed, or should your vision suddenly be reduced, you must seek professional attention immediately.
Inflammation of any cause can bring on rejection and graft failure. Early attention to the cause of rejection can prevent graft failure. There is someone on duty at Flinders Medical Centre 24 hours a day, 7 days a week to attend to patients who have concerns about their grafts. Rejection is the term applied to describe the inflammatory response of a patient to a graft from another person.
We are all truly unique individuals and have evolved mechanisms that protect us from invaders, particularly germs, but also from tissue from other animals, including other human beings. To a large extent these protective mechanisms depend on blood vessels for "lines of communication". Kidneys, livers, hearts and lungs have many blood vessels and hence grafts of these organs are prone to rejection.
The cornea does not usually contain blood vessels so that rejection is much less of a problem. Rejected corneal grafts become inflamed and unless the rejection is reversed the graft function will fail. The graft will become thicker, less transparent and the patient's vision will deteriorate. There are two types of endothelial keratoplasty. The first type, called Descemet stripping endothelial keratoplasty DSEK , uses donor tissue to replace about one-third of the cornea.
The second type, called Descemet membrane endothelial keratoplasty DMEK , uses a much thinner layer of donor tissue. The tissue used in DMEK is extremely thin and fragile. This procedure is more challenging than DSEK and is commonly used. Anterior lamellar keratoplasty ALK. Two different methods remove diseased tissue from the front corneal layers, including the epithelium and the stroma, but leave the back endothelial layer in place. The depth of cornea damage determines the type of ALK procedure that's right for you.
Superficial anterior lamellar keratoplasty SALK replaces only the front layers of your cornea, leaving the healthy stroma and endothelium intact. A deep anterior lamellar transplant DALK procedure is used when cornea damage extends deeper into the stroma. Healthy tissue from a donor is then attached grafted to replace the removed portion. Your doctor will discuss which method of corneal transplant surgery is best for you, what to expect during the procedure and explain the risks of the procedure.
On the day of your cornea transplant, you'll either be given a sedative to help you relax and a local anesthetic to numb your eye, or you'll be put to sleep. Either way, you shouldn't feel pain. Surgery is done on one eye at a time. The amount of time spent in surgery is different and depends on your situation. 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, see your eye doctor annually. Cornea rejection can often be managed with medications. Corneal eye disease is the fourth most common cause of blindness after cataracts , glaucoma and age-related macular degeneration and affects more than 10 million people worldwide.
More than 47, cornea transplants will be performed in the United States in , according to an estimation by the Eye Bank Association of America. Since , more than one million people have had their sight restored with a cornea transplant.
A healthy, clear cornea is essential for good vision. If your cornea is damaged due to eye disease or eye injury, it can become swollen, scarred or severely misshapen and distort your vision.
A corneal transplant might be required in cases of conditions such as trichiasis, where eyelashes turn inward and rub against the surface of the eye, causing scarring and vision loss. A cornea transplant may be necessary if eyeglasses or contact lenses can't restore your functional vision, or if painful swelling can't be relieved by medications or special contact lenses. Certain conditions can affect the clarity of your cornea and put you at greater risk of corneal failure. These include:.
Scarring from infections, such as eye herpes or fungal keratitis. Scarring from trichiasis , when eyelashes grow inwardly, toward the eye, and rub against the cornea. Hereditary conditions such as Fuchs' dystrophy.
Chemical burns of the cornea or damage from an eye injury. Excessive swelling edema of the cornea. Corneal failure due to cataract surgery complications. A cornea transplant is performed to improve the function of the cornea and improve vision. If pain is caused by a significantly diseased or damaged cornea, a cornea transplant may relieve that symptom.
With these factors in mind, you also should consider several important questions before you decide to undergo a corneal transplant:. Does your functional vision impede your job performance or your ability to carry out daily activities? Are you able to take enough time off from work or school up to six months to a year in some cases to recover properly?
All of these questions, in conjunction with a thorough screening and consultation with your eye doctor , must be carefully considered before you make the final decision to have a corneal transplant.
Once you and your eye doctor decide a cornea transplant is the best option for you, your name is placed on a list at a local eye bank.
You may need to wait a few days to weeks for suitable tissue from a donor eye to become available for a corneal transplant. Before a donor cornea is released for use in transplant surgery, it is checked for clarity and screened for the presence of any diseases such as hepatitis and AIDS, in accordance with the Eye Bank Association of America's strict medical standards and FDA regulations. Only corneas that meet these stringent guidelines are used in corneal transplant surgery to ensure the health and safety of the graft recipient.
Your eye surgeon will first administer either local or general anesthesia, depending on your health, age, eye injury or disease, and whether or not you prefer to be asleep during the procedure. If local anesthesia is used, an injection is made into the skin around your eye to relax the muscles that control blinking and eye movements, and eye drops are used to numb your eye.
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