With review and feedback from CEENTA Ophthalmologist Lee Wiley, MD (Pineville, Steele Creek)
If your eye has been injured or has a disease, you may need a corneal transplant. Today, we want to discuss some of the main points about this valuable surgical procedure.
The cornea is the clear, dome-shaped surface that covers the front of the eye. It is made up of 5 different layers and helps to protect the eye from germs, dust and other harmful matter. It functions like a window and helps focus the entry of light into the eye, contributing between 65-75 percent of the eye's total focusing power.
A corneal transplant is needed if vision cannot be corrected satisfactorily with eyeglasses or contact lenses, or if pain cannot be relieved by medications or special contact lenses. There are many conditions that can affect the clarity of the cornea. For instance, trauma or infection, which causes scarring; Fuchs' dystrophy, which causes corneal failure; and Keratoconus, which causes a steep curving of the cornea and blurring of vision. Sometimes cataract surgery and other conditions can cause corneal failure as well.
A corneal transplant is performed with corneal tissue from a deceased human donor. Before a cornea is released for transplant, the donor must meet specific criteria. The tissue is then analyzed for clarity and cellular quality. Testing is performed to rule out viruses and other potentially infectious diseases. Only tissue meeting the highest standards is used for transplantation.
During a traditional penetrating keratoplasty surgery, or “full-thickness” corneal transplant, a circular portion is removed from the center of the diseased cornea. A matching circular area is removed from the center of a healthy, clear donor cornea. It is then placed into position and sutured into place. This type of transplant is often performed for conditions such as deep corneal scars or advanced keratoconus, among others.
An endothelial keratoplasty, or “partial” corneal transplant involves replacing just the inner layer of cells (endothelial cells), which act to keep the cornea clear. The abnormal cells are removed and a thin disc of donor tissue containing a healthy endothelial cell layer is placed on the back surface of the cornea to replace the abnormal endothelial cells. A small air bubble is placed within the eye to push the endothelial cell layer into place until it heals in an appropriate position. This is the procedure of choice for patients with Fuchs’ corneal dystrophy.
With an anterior lamellar corneal transplant procedure, the superficial, or front, layers of the cornea are removed and replaced with donor tissue. Sutures are used to secure the new tissue into place. This is often performed for very superficial corneal scars or keratoconus.
Corneal transplants have proven to be very successful in patients with poor vision, or whose corneas have been significantly damaged because of corneal dystrophies.
“Corneal blindness is often treatable, and we are fortunate to have various methods of corneal transplantation to tailor our approach in order to help restore our patients’ vison and quality of life,” CEENTA Ophthalmologist and Cornea Specialist Lee Wiley, MD, said. “These procedures are very rewarding for both the doctor and the patient because of their high success rates. The endothelial, or ‘partial,’ corneal transplants have dramatically decreased healing time and increased quality of vision. For these reasons they have become my favorite procedures to perform.”
Corneal transplants are done on an outpatient basis and take 30 minutes to an hour to perform. Either mild “twilight” sedation or general anesthesia are used depending on the type of procedure and needs of the patient. There should be no pain during the procedure and your vision will be blurry afterwards. Partial corneal transplants provide improved vision within a few weeks whereas full thickness corneal transplants often take a few months to achieve stable vision. Your doctor will prescribe medicine to aid with the healing process.
This depends on each specific patient scenario but improvement in vision can be expected. Some patients will require glasses or a contact lens after a transplant to provide them with their best vision. Your eye doctor will monitor your vision during the healing process.
Unlike other organ transplants, which require aggressive medication regimens to prevent rejection, corneal transplants only require occasional steroid eye drops. These eye drops typically begin at four times per day and are tapered down as the transplant heals. Rejection rates are low, but if it occurs the transplant can be repeated.
If you have cornea issues, make an appointment at CEENTA. Our cornea specialists will take care of your needs and, if a transplant is necessary, work hard to ensure the best outcome.
This blog is for informational purposes only. For specific medical questions, please consult your doctor. Would you like an appointment with Dr. Wiley? Call 704-295-3000. You can also schedule an appointment online or through myCEENTAchart.
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