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Overview of Corneal Transplant

A corneal transplant involves replacing a diseased or scarred cornea with a new one. When the cornea becomes cloudy, light cannot penetrate the eye to reach the light sensitive retina. Poor vision or blindness may result. The corneas are usually donated from an eye bank for this procedure, and eye drops are needed after the surgery.

When possible, the eye care specialists on the medical staff at Baylor Scott & White Health will do a partial replacement of the cornea such as an endothelial keratoplasty or anterior lamellar keratoplasty. These newer surgeries are usually safer and result in quicker return of vision. However, many conditions are still best managed with a full thickness corneal transplant called a penetrating keratoplasty.

Corneal Transplant Surgeries

Descemet Membrane Endothelial Keratoplasty (DMEK)

This is the newest type of corneal transplantation that is only being done at a limited number of locations.  During this procedure, Dr. Aaker will remove the cells in the back of the cornea and replace them with the identical tissue from the donor (1/100th of a millimeter thick) which is attached with an air bubble. The front of the cornea is left unchanged except for a small incision. This surgery usually only requires one stitch compared to sixteen or more for a typical cornea transplant. Vision returns much quicker after this surgery and there often is complete visual rehabilitation by four weeks. The highest percentage of patients are corrected to 20/20 after this surgery compared to other types of corneal transplants.  This is usually the preferred transplant for Fuchs dystrophy.

Descemet Stripping Endothelial Keratoplasty (DSEK)

During this procedure the cells in the back of the cornea are removed and replaced with a thin piece of cornea tissue which is attached with an air bubble.  It is similar to DMEK, but utilizes a thicker piece of tissue.  Some people are not a candidate for DMEK, but are still a good candidate for this surgery.  It usually requires three stitches and vision may be finalized as soon as six weeks. This is usually preferred for bullous keratopathy and sometimes for Fuchs dystrophy.

Anterior lamellar keratoplasty

In this partial replacement procedure only the front part of the cornea is removed and replaced with the front of another cornea. It is attached with a very fine thread which may be left in place for months or even years. This type of surgery decreases the risk of rejection, damage from trauma, and risk of the surgery. This surgery is often used for keratoconus, and corneal scars.

Penetrating keratoplasty

This surgery removes the full thickness of the central cornea and can be used when there is damage to all layers of the cornea. It also uses a very fine thread that may be left in place for months or even years. This is also often used for infections, and other conditions with severe damage.

Frequently Asked Questions

What are the benefits of corneal transplant surgery?

The primary benefit of corneal transplantation is total restoration of vision.

What are the risks of corneal transplant surgery?

The risk of corneal transplant include:

  • Astigmatism, which can be caused by a ripple in the tissue during surgery. Corrective lenses may be needed to correct this problem.
  • Glaucoma (high pressure in the eye that can cause vision loss).
  • Sometimes, the body rejects the corneal tissue. Medication is given to the patient after the transplant surgery to help their body accept the corneal tissue. In a small number of patients, however, the body rejects the donor cornea, resulting in cloudy vision. If rejection does occur, a second transplant can be performed.
  • Blindness if the surgery is not successful.

Who’s eligible for a corneal transplant?

To determine who is a good candidate for a corneal transplant, the patient must be evaluated. Patients are considered suitable if they have considerable corneal deterioration. Patients are usually referred for a transplant by their ophthalmologist and are scheduled for a corneal consultation with us if the physician suspects corneal damage.

How do I know if I have corneal deterioration?

Your vision will be cloudy; you will not be able to see clearly through the affected eye.

Do I have to meet certain medical criteria to receive a donor cornea?

No, although you must otherwise be healthy enough for surgery. Patients undergoing a corneal transplant will be able to use any donated cornea. Unlike other types of transplants, corneal transplants do not require the donor and recipient to have the same blood type.

Nevertheless, sometimes the body rejects the foreign tissue. Anti-rejection medication is given to the patient after the transplant surgery to help their body accept the corneal tissue. If rejection does occur, a second transplant can be performed.

Who are the donors?

Donors are deceased individuals who, prior to death, agreed to donate their organs. Baylor Scott & White coordinates with eye banks, such as the Lonestar Lion’s Eye Bank in Manor, Texas, to secure corneas for transplantation.

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