Corneal Transplantation

What You Need to Know

  • The cornea is the clear front part of the eye that allows light to enter. A clear cornea is required for normal vision.
  • Corneal transplantation, or keratoplasty, replaces a severely damaged cornea with a donated one.
  • Corneal transplantation can involve replacing the entire cornea or select parts of the cornea depending on the location of the damage.
  • Risks of corneal transplantation are based on a variety of factors including your age, pre-existing health conditions and the original reason for transplantation.
  • Risk of corneal transplant rejection varies from low to high and depends on various factors. A recent study found that corneal transplant rejection occurs largely due to patients not using medications properly and consistently after surgery.

What is corneal transplantation?

Corneal transplantation, or keratoplasty, is a surgery that replaces your poorly functioning cornea with a new donated one. The cornea is the clear front part of the eye that allows light to enter. It also helps focus light into your eye. Different medical problems can damage your cornea. They can make it cloudy and opaque or distort its shape. If this happens, your vision can be impaired. In some cases, corneal damage can even lead to blindness.

Do I need corneal transplantation?

If you have scarring or damage to your cornea, your vision can be impaired. Your eye doctor may need to treat the underlying cause of the damage to your cornea. If the damage is severe enough, you might need corneal transplantation to restore your sight. Conditions that might require corneal transplantation include:

  • Complications from cataract or other eye surgery

  • Corneal dystrophy

  • Corneal scarring

  • Corneal swelling

  • Infection of the cornea

  • Previous eye trauma or injury

  • Keratitis

  • Keratoconus

If the damage to your cornea is minor, you may not need corneal transplantation.

Types of corneal transplantation

  • Advances in corneal transplantation allow for replacing all or part of the cornea depending on the location of damage. As a less invasive approach, partial corneal transplantation can have advantages, including lower risks and faster recovery.

  • Penetrating keratoplasty involves replacing the entire cornea with a healthy donor cornea.

  • Endothelial keratoplasty involves replacing the inner layer of the cornea with a healthy inner layer of a donor cornea.

  • Anterior lamellar keratoplasty involves replacing the outer layer of the cornea with a healthy outer layer of a donor cornea.

  • Keratoprosthesis involves replacing the entire cornea with an artificial cornea. This procedure is used when a cornea is so severely damaged that it cannot be repaired with a natural donor cornea. 

What are the risks of corneal transplantation?

While approximately 40,000 corneal transplants are conducted each year in the U.S., complications can occur, which include:

  • Bleeding in the eye

  • Cataracts

  • Detachment of the new cornea

  • Eye inflammation

  • Refractive errors, requiring glasses or contact lenses

  • Onset or worsening of glaucoma

  • Severe infection inside the eye (endophthalmitis)

  • Severe infections on the surface of the eye (eye ulcer or abscess)

  • Retinal detachment

Another possible complication is rejection of the donated cornea. Your immune system might recognize that the tissue is foreign, and create an immune response that rejects the new cornea. Risk of transplant rejection ranges from low to high and depends on a variety of factors. A recent study showed that some transplanted corneas are rejected because patients fail to comply with medication instructions after surgery. Corneal transplant rejection is generally reversible, and if addressed quickly, may not impact negatively the function of the transplanted cornea.

Overall risk for complications differs based on a variety of factors that may include your age, pre-existing medical conditions and the original reason for your corneal transplantation. Ask your eye doctor about your own risks for corneal transplantation.

What should I expect after corneal transplantation?

Ask your eye doctor about what you should expect after your surgery. In most cases, you will be able to go home the same day, but will need someone to drive and accompany you there. You will also need to carefully adhere to post surgery instructions, paying special attention to medications that your doctor prescribes.

Tell your eye doctor right away if you have any signs of complications, including rejection. These might include symptoms such as:

  • Decreased vision

  • Increased eye pain

  • Increased eye redness

  • Increased sensitivity to light

You may not be able to see well shortly after surgery as the transplant begins to heal. Fortunately, most people who have corneal transplantation will go on to have improved vision for many years.

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