Corneal transplantation
About corneal transplant
If your corneal dystrophy has progressed to a stage that a corneal graft is being considered, several changes to your cornea will have taken place. Firstly, the dystrophy will have damaged or distorted your cornea to a point where the vision can no longer be improved sufficiently with spectacles or contact lenses and, secondly, medical treatment may no longer be able to relieve any pain caused by the dystrophy.
However, the graft operation will only go ahead once you have discussed your condition fully with your eye specialist and you have come to an agreement that this is the best way forward.
What happens during a corneal transplant
A corneal transplant is the way of removing your damaged cornea and replacing it with a healthy cornea from the eye of a suitable donor. The donor will be a person who has (or whose family has) given consent for their corneas to be used for medical purposes after their death. The donor cornea is thoroughly checked and prepared to ensure there is no possibility of it being infected.
The operation can be carried out either under local or general anaesthetic. This will generally be a matter of discussion between you and your eye specialist. The operation involves the removal of a circular piece of the affected cornea and replacing it with a piece of the donor cornea of exactly the same size and shape.
This new section of cornea is then sewn into place with very fine stitches. The stitches may be noticeable as they make a distinctive star-like pattern around the outer edge of the cornea. The operation can take in the region of one hour, although some may be more complicated and take longer.
Your eye is never removed and replaced during an operation.
At the moment a number of new surgical procedures are being tested and developed which may mean a quicker recovery from a corneal transplant.
Current surgery provides excellent results in most cases, but developments in the future may mean even better results and recovery times for people with corneal dystrophies.
After the operation
You may have to stay in hospital for a day or two, but some people are able to go home on the day of the operation. The operated eye may be covered with an eye pad and a plastic eye shield, which would be removed the day after the operation. If you feel any discomfort or pain, do ask for pain relief.
When the pad is removed you may find that your vision will be blurred. This is quite normal. Your eye may also be a bit watery and sensitive to light. You will be given eye drops to use, some of which you may require for months and years. The drops help to reduce the likelihood that your body will reject the transplant. It can take more than a year for the transplant to heal completely.
A few months after the operation, it may be necessary to have either spectacles or contact lenses to obtain the best possible vision from the transplant. However, your vision may fluctuate as the transplant heals.
Risk of rejection
While great care is taken to ensure the donor eye is a suitable match, sometimes the immune cells of the body reject the new tissue. This usually happens within the first year after the operation, but can also happen years later. While roughly three quarters of all grafts survive 5 years, each condition has a different possibility of rejection. Therefore, this is something that should be discussed with your eye specialist before going ahead with the operation.
The signs that the transplant is being rejected include a combination of the following:
• pain
• red eye
• blurred vision
• sensitivity to light.
On the whole, corneal transplants for corneal dystrophies have a very low rate of rejection. If you ever feel that there is a problem with your transplant you must seek medical advice immediately at your nearest eye department. Graft rejection doesn't necessarily mean that the transplant will fail. With prompt treatment the outcome is usually good.
Contact lenses
It is possible that, following your transplant, contact lenses may be used either to aid the healing of the transplant, or as an alternative to glasses because they allow better vision. However, the decision about whether contact lenses are suitable will be made following your operation.
Other complications
It is possible that with some types of corneal dystrophy, especially the stromal dystrophies, the dystrophy will return at some point following the graft. Please discuss this possibility with your eye specialist before you have the operation.
Benefits of corneal transplants
The success rate of corneal transplants as a treatment for corneal dystrophies is very high. For a graft to be considered, the dystrophy will already have caused serious sight loss and a corneal transplant offers a good opportunity to return to having good vision.
What next?
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Useful contacts
Unfortunately there is not a general support group for people with corneal transplantation.
There is a support group for people with Keratoconus which can be contacted at:
Keratoconus Self Help and Support Group
PO Box 26251
London
W3 9WQ
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