CORNEAL TRANSPLANTS

What are Corneal Transplants?

The cornea can be thought of as the "window of the eye." It is a clear structure in the front of the eye, which allows light to pass through to the retina unobstructed. The curvature of the cornea bends the light rays to focus them on the retina producing clear images and normal vision.

Several diseases and sometimes trauma to the cornea can alter its structure in a way which produces visual loss. Changes in corneal shape, thickness, or clarity that result in poor vision can often be corrected with transplants.

The transplant procedure involves removing a circle of tissue (about 8mm in diameter) from the patient's cornea, and replacing this tissue with corneal tissue from a human donor. The donor tissue is carefully screened to prevent transmission of disease to the recipient. The new donor cornea is stitched into position using very thin nylon thread. These sutures are barely visible and do not cause pain, although it is normal for the eye to feel scratchy or irritated for the first few days after surgery. During the first few weeks after the surgery the vision is usually blurry. After several weeks the vision begins to clear and within 3 or 4 months new spectacles can be prescribed which often sharpen the vision even more.

As with any type of surgery, there are risks to corneal transplant surgery. Infection or bleeding in the eye can be very serious problems, but rarely occur. Other risks include cataract, retinal detachment, glaucoma, donor failure, and donor rejection. Most of these complications can be either repaired surgically or controlled with medications. Your doctor will discuss these risks in detail with you prior to surgery.

Corneal transplantation has evolved into a highly successful procedure.  About 90% of patients experience an improvement in their vision following this procedure. This surgery is usually performed on an outpatient basis, meaning patients do not have to spend the night in the hospital.

DSEK Procedure

Dr. Perl and Corneal Associates of New Jersey are excited to offer a new state-of-the-art procedure for their patients in need of a corneal transplant. With some corneal diseases, the cornea may develop what looks like cloudy vision. What is actually happening is the eyes endothelial cells have become damaged. These cells are located at the back of the cornea. Since it’s only these cells that are damaged, a patient can forego having a complete corneal treatment and have a partial one instead.

DSEK or Descemet’s Stripping Endothelial Keratoplasty is the new method used during corneal transplant procedures. Corneal Associates of New Jersey is one of the few practices in the US to be performing this new treatment. In DSEK, a surgeon uses special instruments to enter the clear, front part of the eye (cornea). Next, the surgeon removes the rear part of the cornea (Descemet’s Membrane). Once the damaged Descemet’s Membrane has been removed, a donor membrane is inserted.

Two main plusses from having this treatment are that there are no stitches after the procedure and, because of the lack of stitches, fewer follow up exams are needed. Like many procedures, DSEK may not be appropriate for some people with particular corneal diseases. The knowledgeable staff of Corneal Associates of New Jersey can help decide if DSEK is appropriate for you.

Who Can Benefit From Corneal Transplants?

Corneal transplantation can help people who have diminished vision due to diseases or trauma to the cornea that alters its structure in a way that produces visual loss. These include:

• Changes in corneal shape: The normal cornea has a fairly spherical curvature. In a disease known as keratoconus, the cornea can protrude outward forming a cone-like curvature which causes visual loss. This disease is thought to be inherited, and usually begins to produce loss of vision sometime in the late teens and early adult years. Contact lenses and glasses sometimes can improve vision in patients with keratoconus, but sometimes removal of the cornea and placement of a donor cornea (corneal transplantation) is necessary to restore good vision. See our page on Keratoconus
  
• Changes in corneal thickness: Corneal edema, a build-up of fluid or swelling of the cornea, can produce loss of vision. This can occur as a result of cataract surgery or can occur spontaneously due to corneal dystrophies or inflammation of the cornea. The cornea becomes thickened and cloudy, thus obstructing the passage of light through the eye. When inflammation or infection is the cause of edema, antibiotics or anti-inflammatory drops can be prescribed which reduce the swelling. When the edema occurs after cataract surgery or is due to a dystrophy of the cornea, a corneal transplant is often necessary.
• Changes in corneal clarity or opacity of the cornea: The normally clear cornea can sometimes become cloudy due to scarring after an injury or an infection. The scar tissue or opacity prevents the clear passage of light through the cornea and thus results in loss of vision. Sometimes scar tissue can be removed with a laser (excimer laser phototherapeutic keratectomy or PTK). When the scar extends into the deeper corneal tissues a corneal transplant is usually necessary to restore vision.

Pre-Op

Prior to being accepted for transplant surgery at Corneal Associates, you will need to undergo a thorough eye exam to confirm that you will benefit from surgery. You are likely to be examined by more than one doctor.

As with any surgery, it is best for you to be well-rested and well-hydrated before the procedure. You will also need to arrange for a family member or friend to escort you home after the procedure.

Post-Op

After the procedure, you will need to take it easy for several days. It is essential that you take the medicated drops we prescribe to diminish the chances of infection. The stitches which are used in the procedure will be removed a few at a time. You will need to return to Corneal Associates several times.

Recovering From A Transplant

It will take about 9 months for you to recover fully. During that time, you will need to protect the eye as much as possible with dark or shaded glasses. You will make several return visits to Corneal Associates so we can monitor your progress and remove stitches. In most cases, we are able to tell patients that they are fully recovered in 9 months to one year. In the few cases where we have to perform enhancements to remove scar tissue, the recovery period can be longer.

Patients Speak About Corneal Transplants

"Dr. Perl set realistic expectations. told -me that the recovery would take several months, as the stitches were removed one at a time. Everything happened on schedule, exactly as Dr. Perl explained. Once Dr. Perl removed the final sutures, I now have 20/20 vision and back flying jets for a living. I am grateful to the doctor for restoring my eyesight."
Bill Meyer - Westfield, NJ