The cornea is the clear structure at the front of the eye. It helps focus light to allow for clear vision. When the clarity or shape of the cornea is severely compromised, a corneal transplant may be required to restore vision. During a corneal transplant, the diseased cornea is replaced using healthy tissue from an organ donor. Unlike other organ transplants, corneal transplants may be scheduled as routine, elective surgeries and are performed as outpatient procedures. If the entire cornea is affected, a full-thickness corneal transplant may be indicated. However, newer techniques allow for selective replacement of the involved cornea layers, while leaving the healthy layers in place.
Many corneal diseases and injuries that damage the cornea may be improved with corneal transplantation. Examples include:
During a full-thickness corneal transplant (Penetrating Keratoplasty), the diseased cornea is removed and a new cornea is secured into place using many fine stitches. This type of corneal transplant has a longer recovery than most partial corneal transplant techniques. Full recovery typically takes 1-2 years.
The cornea is made of 5 distinct layers. These layers are epithelium, Bowman layer, stroma, Descemet membrane, and endothelium. Newer surgical techniques allow for selective replacement of individual layers if some parts of the natural cornea remain healthy. When only the front and middle layers of the cornea are damaged, they may be replaced while leaving the thin inner lining of the cornea in place. This transplant is called Deep Anterior Lamellar Keratoplasty (DALK). This technique is often used to treat keratoconus and scars of the cornea. Like full-thickness transplants, the donor tissue is secured using many fine stitches and recovery often requires 1-2 years.
Some other conditions, such as Fuchs corneal dystrophy, cause damage to the innermost lining of the cornea called the endothelium. The most common techniques to replace the corneal endothelium include Descemet Membrane Endothelial Keratoplasty (DMEK) and Descemet Stripping Automated Endothelial Keratoplasty (DSAEK). In these state-of-the-art procedures, the graft tissue is held in position using an air or gas bubble in the front of the eye. The bubble dissolves over a period of days, leaving the transplanted tissue in place. With these techniques, often few or no stitches are required. Compared to full-thickness corneal transplants, these techniques allow for better and more rapid visual recovery, less astigmatism and shifting of glasses prescription, and lower risk of transplant rejection.
Your doctor will schedule a clinic visit to evaluate and discuss your condition. At this visit, you will undergo a detailed eye examination including vision assessment, measurement of your glasses prescription (refraction), measurement of your corneal thickness (pachymetry), and mapping of the corneal shape (topography). Other imaging such as OCT scans or photos of your eyes may also be recommended for some cases. These measurements help your doctor assess how to best treat your eyes. After evaluating the results of these measurements and examining your eyes, your doctor will discuss whether treatment is indicated and which procedure is recommended for you.
After the procedure, the eye usually feels irritated or painful for days to weeks. You will have several clinic appointments during the first year after surgery. You will be asked to place drops in the eye for multiple months after the procedure to help with healing. Long-term steroid drops are often recommended to prevent rejection and maintain the health of your transplant.
Vision in the eye will likely be very blurry during the initial healing period. The vision gradually improves over weeks to months. Your glasses prescription will likely shift as the eye heals. If needed, glasses may often be updated when the eye stabilizes. Vision recovery may range from a few months to many months depending on the type of transplant.
Associated Eye Care offers treatment for cornea problems at our clinic on Curve Crest Boulevard in Stillwater. Cornea transplant consultations are scheduled with Dr. Vislisel at our Stillwater and Woodbury locations. Schedule an appointment now or call (800) 846-1877 for more information.