Corneal Transplantation

A cornea transplant is most often used to restore vision to a person who has a damaged cornea. A cornea transplant may also relieve pain or other signs and symptoms associated with diseases of the cornea. Greater Ohio Eye Surgeons have two fellowship trained cornea specialists with extensive experience in corneal transplantation: Dr. Fish and Dr. Storck.

A number of conditions can be treated with a cornea transplant, including:

  • A cornea that bulges outward (keratoconus)
  • Thinning of the cornea
  • Cornea scarring, caused by infection or injury
  • Clouding of the cornea
  • Swelling of the cornea
  • Corneal ulcers, including those caused by infection
  • Complications caused by previous eye surgery

Descemet’s Stripping Endothelial Keratoplasty (DSEK)

DSEK is the latest corneal transplantation procedure that does not require the removal of the whole cornea. Instead, the innermost layer of the cornea is replaced. DSEK has several advantages over traditional penetrating keratoplasty, including rapid visual recovery (weeks to months as opposed to months or years), less astigmatism, early suture removal and less complications.

In conditions such as Fuchs endothelial dystrophy, the innermost layer called the endothelium is diseased. This results in swelling of the cornea causing decreased vision. Previously, to replace the valuable endothelial layer the whole central cornea was replaced by performing a Penetrating Keratoplasty. With innovative techniques, we are now able to replace just the innermost layer.

The procedure involves peeling off the inner two layers of the diseased cornea. A donor cornea is then split or dissected to create a flap of the inner two layers and a small portion of stroma (to provide substance for manipulation). This three-layer donor is folded and inserted into the eye. It is then unfolded and lifted up against the patient’s cornea using an air bubble. The air bubble is left in the eye to hold the donor cornea in position, and will dissolve over the course of a few days leaving the donor cornea to naturally adhere to the patient’s eye. Sometimes the graft does detach from the host cornea in the early post-operative period and has to be repositioned with a new air bubble.

Full Thickness Penetrating Keratoplasty (PKP)

This is considered the “traditional” type of transplant and this technique has been around for decades. During penetrating keratoplasty, your surgeon cuts through the entire thickness of the abnormal or diseased cornea to remove a small button-sized disc of corneal tissue. An instrument that acts like a cookie cutter (trephine) is used to make this precise circular cut.

The donor cornea, cut to fit, is placed in the opening. Your surgeon then uses tiny stitches to suture the donor cornea into place. The sutures are left in place for several months to years depending on the patient. Although penetrating keratoplasty isn’t performed as often these days because of new transplant techniques, it is still the best option for many patients.

Corneal transplantation risks

Corneal transplantation surgeries are safe and common procedures, but there are risks of the following side effects:

  • Infection
  • Increased risk for cataracts
  • Increased risk for glaucoma
  • Complications with stiches
  • Donor cornea rejection
  • Swelling

Because of these risks, it is important to attend all follow-up appointments with your physician to detect early recognition.

Corneal donation

Most corneas used in cornea transplants come from deceased donors. Unlike with other organs, such as livers and kidneys, people needing cornea transplants generally don't have to endure long waits. That's because nearly all donated corneas are viable after a donor’s death, so more corneas are available for transplant compared with other organs. In addition, unlike other organ transplants, strong immunosuppressive drugs are usually not required to prevent rejection of a cornea transplant. Most often, only steroid eye drops are needed to prevent rejection.

Signs & symptoms of corneal rejection

Donor cornea rejection may occur if you are showing signs of vision loss, pain, redness or sensitivity to light. Steroid eye drops are typically used to prevent rejection, but it is still recommended to contact your physician.

Rejection occurs in about 20 percent of cornea transplants. Put another way, two out of every 10 people receiving cornea transplants can expect to experience rejection. It is not uncommon to keep patients on steroid drops for the rest of their life to lower the risk of rejection.

Schedule an appointment with Dr. Fish or Dr. Storck today.