What is Cornea Transplant

A cornea transplant, also known as keratoplasty, is a surgical procedure that involves replacing a damaged or diseased cornea with healthy corneal tissue from a donor. The cornea is the clear, dome-shaped surface that covers the front of the eye, playing a crucial role in focusing light and contributing to about two-thirds of the eye's optical power. When the cornea becomes scarred, swollen, or misshapen, it can severely impair vision. A cornea transplant can restore or improve vision, relieve pain, and in some cases, save the eye itself.

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The Anatomy of the Cornea

Before diving into the details of a cornea transplant, it’s essential to understand the structure and function of the cornea. The cornea is composed of five layers:

• Epithelium
• Bowman’s Layer
• Stroma
• Descemet’s Membrane
• Endothelium

Why Is a Cornea Transplant Necessary?

A cornea transplant is typically recommended when the cornea is damaged due to disease, injury, or other medical conditions that cause vision impairment. Common reasons for a cornea transplant include:

• Keratoconus: A condition where the cornea thins and bulges outward, creating a cone shape that distorts vision.

• Fuchs’ Dystrophy: A genetic disorder that causes the endothelial cells to deteriorate, leading to corneal swelling and vision loss.

• Corneal Scarring: Resulting from infections, such as herpes simplex, or injuries that cause significant damage to the cornea.

• Corneal Edema: Swelling of the cornea due to fluid buildup, often related to previous eye surgeries like cataract removal.

• Corneal Ulcers: Open sores on the cornea, usually caused by infection, that can result in scarring and vision loss.

• Rejection of a Previous Corneal Transplant: In some cases, a previous cornea transplant may fail, necessitating a repeat procedure.

Types of Cornea Transplants

Cornea transplants can be classified into several types depending on the extent of the tissue replacement

• Penetrating Keratoplasty (PK): This is the traditional full-thickness cornea transplant where the entire damaged cornea is removed and replaced with a donor cornea. PK is often used when the damage extends through most of the cornea’s layers.

• Endothelial Keratoplasty (EK): This procedure involves replacing only the innermost layers of the cornea, the Descemet’s membrane, and the endothelium. EK is further divided into two subtypes:

• Descemet’s Stripping Endothelial Keratoplasty (DSEK or DSAEK): Where a thin layer of the cornea, including the endothelium and a portion of the stroma, is transplanted.

• Descemet’s Membrane Endothelial Keratoplasty (DMEK): This is a more advanced form of EK, where only the Descemet’s membrane and endothelium are transplanted. DMEK offers faster recovery and better visual outcomes but is technically more challenging.

• Anterior Lamellar Keratoplasty (ALK): In this procedure, the damaged outer layers of the cornea (epithelium, Bowman’s layer, and stroma) are replaced, leaving the healthy inner layers intact. ALK is further categorized into:

• Superficial Anterior Lamellar Keratoplasty (SALK): Used when only the superficial layers of the cornea are affected.

• Deep Anterior Lamellar Keratoplasty (DALK): Used when deeper layers of the cornea are involved, but the endothelium remains healthy.

• Keratoprosthesis: In rare cases where a donor cornea is not suitable or available, an artificial cornea (keratoprosthesis) may be used.

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The Cornea Transplant Procedure

The cornea transplant operation is typically performed as an outpatient, which means the patient can return home the same day. Here's a summary of what you may expect:

• Preoperative Assessment: Before the surgery, a thorough eye examination is conducted to determine the extent of corneal damage and the most suitable type of transplant. The surgeon will also assess the patient's overall health and discuss any potential risks or complications.
• Donor Tissue Preparation: The healthy donor cornea is obtained from an eye bank. The donor tissue is carefully screened for any diseases or infections to ensure its suitability for transplantation.
• Anesthesia: The surgery is typically performed under local anesthesia, meaning the patient remains awake but the eye is numbed. In some cases, general anesthesia may be used, particularly in children or anxious patients.
• Surgery: The surgeon begins by removing the damaged portion of the patient’s cornea. In a PK procedure, a circular portion of the cornea is removed using a surgical tool called a trephine. The donor cornea is then sutured into place using fine stitches. In EK or ALK procedures, only the affected layers are removed and replaced with the corresponding layers from the donor tissue.
• Postoperative Care: After the surgery, the eye is covered with a protective shield, and the patient is given eye drops to prevent infection and reduce inflammation. The patient will need to attend follow-up appointments to monitor the healing process and ensure the transplant is successful.

Risks and Complications

While cornea transplants are generally safe, like any surgical procedure, they carry some risks. Potential complications include:

• Rejection: The immune system may recognize the donor cornea as foreign and try to reject it. Signs of rejection include redness, pain, sensitivity to light, and decreased vision. Prompt treatment with anti-rejection medications can often prevent graft failure.
• Infection: There is a risk of infection during or after the surgery, which can lead to serious complications if not treated promptly.
• Glaucoma: Increased pressure inside the eye (glaucoma) can develop after a cornea transplant, potentially damaging the optic nerve and leading to vision loss.
• Astigmatism: The shape of the cornea after a transplant may cause irregular astigmatism, leading to blurred or distorted vision. Glasses or contact lenses can often correct this issue.
• Graft Failure: In some cases, the transplanted cornea may not function properly, leading to graft failure. This may require a repeat transplant.
• Vision Problems: While many patients experience improved vision after a cornea transplant, some may still have residual vision problems that require correction with glasses or contact lenses.

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