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Cornea
is the transparent tissue which forms the outer layer of an eye. Sometimes
cornea becomes opaque, or its shape can change. In this case the visual acuity
of a person will decrease.
In
corneal transplantation surgery the corneal layer which cannot fulfill its
function is replaced with the transparent donor corneal layer taken from a
cadaver.
Corneal
transplantation is performed in different ways according to lesion location. If
the disease has affected all the corneal layers, then full-thickness
(penetrating) corneal transplantation will be performed. If the disease has
affected the anterior (front) part of the cornea and the shape of the cornea as
in keratoconus disease, then only the anterior surface of the cornea can be
replaced. We call it deep anterior lamellar keratoplasty (DALK). If the damage
is only on the posterior part of cornea, then we change only that posterior
part. When posterior (back) part of cornea is changed there is no suture, which
is why astigmatism does not occur. It is called posterior lamellar keratoplasty
(PLK).
Specially designed trepans and punches are used for corneal
transplantation surgery. Sometimes laser can also be applied for corneal
incisions.
In
penetrating keratoplasty, general anesthesia is usually preferred. Lamellar
keratoplasty surgeries are performed under general or local anesthesia.
Duration of Surgery
Depends on the type of surgery and varies
between 45 to 120 minutes.
Follow-ups
after the surgery are very frequent for the first few months and go on totally
at least within 1 year. After this, patients will have eye drops treatment in
very small amounts for protective purposes for a lifetime.
Treatment Success Rate
Corneal
transplantation success rate depends on the disease and surgical technique.
According to
5-year survey, it may vary from 60 to 95%.
The treatment success rate depends on such factors as: the type
of the previous disease, presence or absence of glaucoma, amblyopia, state of
retina that could not be properly observed because of the clouded cornea, optic
nerve and macula diseases and the patient’ s immune system.
Possible Complications
A corneal transplant is considered a fairly safe procedure, but
it is surgery, so there are risks.
In
about 1 out of every 10 transplants, the body's immune system attacks the
donated tissue. This is called rejection. It can be reversed with eye drops
most of the time. Because so little donor tissue is used for DSEK and
especially DMEK, there' s a much lower risk of rejection with these procedures.
Other
things that could happen include:
- Infection
- Bleeding
- Higher
pressure in the eye (called glaucoma)
- Clouding
of the eye's lens (called cataracts)
- Swelling
of the cornea
- A detached retina, when the back inside surface of your eye
pulls away from its normal position.
Important Notes to Maintain Health after the Surgery
It
is imperative to protect the eye from any strokes for a lifetime after surgery
as cornea is a non-vascular tissue, and stromal wound healing can never reach
the level of the healthy tissue.
After
corneal transplantation surgery traumatic wound dehiscence rate is 2.5% (1 out
of every 40 people). That is why combat sports and professions where eye is not
protected against blows must be abandoned.
Recovery Process / Period
The recovery process
after posterior (back) lamellar keratoplasty is very fast, and a patient can
return to his or her daily activities in 1 week after the surgery. As in DALK
and penetrating keratoplasty there are sutures being applied, they can be removed
in about 1 year after. This period can differ according to the type of the
surgery and suture technique.
For Penetrating Keratoplasty
Days of Stay in the
Country: about 2 weeks
Expected After Care
The follow-ups after
the surgery are made on the1st day, 1st week, 1st month and later every month
within 1 year. The doctor can adjust this follow ups schedule and subsequent
follow-ups according to condition of a patent and eye.
Doctor experience with the Procedure
- 1-year
cornea fellowship experience on corneal transplantation at Wills Eye
Hospital,
- Thomas
Jefferson University in the USA and numerous surgical experience in all
corneal transplantation surgeries within 20 years of medical practice.
- In
addition, there is a vast amount of articles in international journals
written on this topic.
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Author & Surgeon: Assoc. Prof.
Dr. Remzi Karadag
Posted: May 11, 2021 at 13:56 UTC
Last Updated: Jan 21, 2022 at 11:39 UTC
Scanned original that contains the doctor stamp and signature
Scientific References:
1.
Feasibility
of Descemet membrane endothelial keratoplasty (DMEK) on PubMed
2.
Descemet
Membrane Endothelial Keratoplasty: Safety and Outcomes on PubMed
3.
Outcomes
for pediatric keratoconus on PubMed