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Planning a Corneal Transplant

Corneal grafting or corneal transplant is a procedure of replacing a damaged cornea with a clear and healthy cornea. The cornea is the transparent layer forming the front of the eye. It can become cloudy due to disease or it can be scarred due to an injury. This can happen even if the remainder of the eye is healthy or normal.

The clear cornea in a corneal transplant is taken from a deceased person. The donor cornea should be checked and prepared thoroughly to remove any possibility of it being infected. The donor and/or his family should have consented to the donation.  In Australia we have Eye Banks that are world recognised in their preparation and distribution of cornea tissue.

When Done

A corneal graft is performed for any of the following reasons:

•    Keratoconus

•    Fuch’s Dystrophy

•    Relieving pain caused by a problem in the cornea
•    Improving vision that cannot be improved with glasses or specialised contact lenses
•    Sealing a hole in the cornea
•    Removing infection in the cornea.

Risks

Just like any other medical procedure, a corneal transplant comes with concomitant risks. While these risks rarely happen as 75% of procedures survive five years, it is best to know what they are:

•    Infection
•    Eye feels sticky or as if something is inside it
•    Graft rejection.

When you undergo the procedure and you exhibit these symptoms afterwards, it is best that you seek professional medical help immediately. You might need an extra treatment or another surgery.

Aftercare post operatively is imperative to minimize complications.

Procedure and Recovery

A corneal graft procedure takes about an hour to complete under a general or local anesthesia. You will have around 16 very fine stitches to sew the cornea in place. You may need to stay in the hospital for one day to four days although some are allowed to undergo out-patient procedures.  Our experience has been that  the majority of patients stay for a morning but must have a follow-up visit the next morning.

After the procedure, your eye may be covered with an eye pad and a plastic eye shield for protection. The cover will be removed a day after the surgery. You may feel that there is something in your eye but it should not be painful. In case of pain, ask your doctor for pain relief. Your eyes would tend to feel watery and sensitive to light too.

After undergoing a corneal transplant, you should avoid bumping your eyes and lifting heavy objects. Swimming should likewise be avoided for at least a month. It would also be advisable to take around a month off from work. Eye drops will be prescribed for use for several months to avoid graft rejection and infection.

When the eye pad is removed, your vision will be blurred initially. Normally, an improvement in vision can be observed within days of undergoing the procedure. Your vision will continue to improve gradually over the months. Optimal vision, with the help of glasses or contact lenses, is usually achieved in a year. It may be longer in some instances.

Before undergoing this procedure, it is best that you discuss the pros and cons with your eye doctor. He will assess whether or not your condition warrants this surgery. He will also advise you on the risks that come with it and other steps you might need to undertake after going through a corneal graft.

What needs to be clear is that even though a corneal transplant is a very successful procedure, approximately 50% of these corneal transplants will fail within 15 years.  The risk for rejection increases with the number of corneal grafts that you have.  It is therefore recommended  that it is used as a last resort so that the later it is done the later the next repeat one will need doing.

About the Author

Dr Jim Kokkinakis (Optometrist) graduated in 1983 from the Optometry School University of NSW. He is currently a Senior Lecturer there and regular speaker to both Optometrists and Ophthalmologists in Australia and Internationally. He has a specialist clinical practice in the Sydney CBD with interests in Eye Strain, Computer Vision problems, Treatment of Eye Diseases and complex Contact lens Fittings.

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