Corneal Transplantation

What is corneal transplantation?

Corneal transplantation is a surgery that replaces your poorly functioning cornea with a new donated one.

The cornea is your eye’s outermost layer. It is a clear, strong layer that caps the front of your eye. It helps protect the rest of your eye from germs and debris. It also helps control the entry of light into your eye. Different medical conditions can damage your cornea, making it cloudy and opaque or distorting its shape. If this happens, it can damage your vision. In some cases, it can even cause blindness.

The most common form of corneal transplantation is called “penetrating keratoplasty.” Your surgeon removes the central part of your damaged cornea. He or she replaces it with a clear cornea from a cadaver donor. Your surgeon then sews this new cornea into your eye. Less commonly, eye surgeons replace only the damaged layer of your cornea. Replacement of the inner layer is called “descement membrane keratoplasty.” Replacement of the outer layer is called “anterior lamellar keratoplasty.” In the United States, surgeons perform corneal transplantation frequently.

Why might I need corneal transplantation?

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

  • Keratoconus
  • Bullous keratopathy
  • Corneal swelling
  • Corneal scar
  • Corneal dystrophy
  • Keratitis
  • Infection of the cornea
  • Injury
  • Complications from cataract surgery

If the damage to your cornea is minor, it may heal on its own without the need for transplantation. If you have a significantly damaged cornea, phototherapeutic keratectomy may be another option. This method uses a laser to etch away part of your damaged cornea. However, this method may not be appropriate for all types of cornea damage.

If you need corneal transplantation, ask your health care provider whether a full-thickness or partial-thickness transplantation would be best for you. Talk with your health care provider about the treatment that makes the most sense for you.

What are the risks of corneal transplantation?

Corneal transplantation has a fairly high success rate. However, sometimes complications do happen and may include:

  • New refractive errors (requiring glasses or contact lenses)
  • Suture vascularization
  • Corneal infection
  • Worsening of glaucoma
  • Endophthalmitis
  • Bleeding in the eye
  • Eye ulcer or abscess
  • Detachment of the new cornea
  • Cataracts
  • Retinal detachment
  • Eye inflammation

There is also a risk that the surgery will not work and that you will have impaired vision.

Another major possible complication is rejection of the donated cornea. Your immune system might recognize that the tissue is foreign and mount an immune response. This can cause the transplant to fail. If this happens, you will probably need another corneal transplantation. To minimize your risk of vision loss from rejection, ask eye doctor what the signs and symptoms of rejection are. If you experience any of these symptoms, see him or her right away, since early treatment may prevent loss of vision.

Your risk for complications may differ based on your age, your other medical conditions, and the reason for your corneal transplantation . Ask your eye doctor about your own risks for corneal transplantation.

How do I prepare for corneal transplantation?

Ask your eye doctor what you need to do to prepare for corneal transplantation. Ask whether you need to stop taking any medications before the procedure. You will need to avoid eating anything after midnight before the day of the procedure.

Your eye doctor may want to use special instruments to shine a light in your eye and examine your cornea. You may need to have your eyes dilated for this eye exam. You also might need computerized corneal mapping, which will give your provider even more information about your cornea.

What happens during corneal transplantation?

Talk with your eye surgeon about what will happen during your surgery. The details may vary somewhat. In general, during the procedure:

  • You may receive anesthesia to put you to sleep. If this is the case, you will sleep deeply through the surgery and won’t remember it afterwards.
  • In other cases, you may be awake during the surgery. You will receive a medication to help you relax. In this case, your health care provider may use anesthetic eye drops and injections to make sure you don’t feel anything.
  • Your surgeon will remove the central portion of your damaged cornea.
  • Your surgeon often uses a very fine thread to sew the new donated cornea in place. Sometimes, your surgeon will place an air bubble inside your eye to keep the new tissue in place, instead of sutures or thread.
  • An antibiotic ointment may be applied to your eye to help prevent infection.
  • Your eye will be patched and covered.

What Happens Afterward?

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. Plan to have someone go home with you after the procedure.

Be sure to follow your health care provider’s instructions about eye care and medications. You may need to take eye drops with antibiotics to help prevent infection. Your eye may be a little sore after the procedure, but you should be able to take over-the-counter pain medications. You may need to wear an eye patch for a day or so. You will also need to take medications to prevent rejection of your new cornea. Ask your eye doctor whether you should avoid any specific activities as you recover. Avoid rubbing your eyes.

You will need close follow-up care so your eye doctor can see whether the procedure was effective. You may have a scheduled appointment the day after the procedure. Your stitches may be removed at a follow-up visit, but this might not be until much later.

Be sure to tell your eye doctor right away if you have any signs of complications, including rejection. These might include symptoms like:

  • Decreased vision
  • Increased eye redness
  • Increased eye pain
  • Increased sensitivity to light

You may not be able to see well right away because of eye swelling. Fortunately, most people who have corneal transplantation will go on to have good vision for many years.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • The risks and benefits of the test or procedure
  • When and where you are to have the test or procedure and who will do it
  • When and how will you get the results
  • How much will you have to pay for the test or procedure