What Is the Cornea?
The cornea is the clear front window of the eye that covers the colored iris and the round pupil. Light is focused
while passing through the cornea so we can see.
How Can an Unhealthy Cornea Affect Vision?
If the cornea is injured, it may become swollen or scarred, and its smoothness and clarity may be lost. Scars, swelling
or an irregular shape can cause the cornea to scatter or distort light, resulting in glare or blurred vision.
A corneal transplant is needed if:
Vision cannot be corrected with eyeglasses or contact lenses
Painful swelling cannot be relieved by medications or contact lenses.
Of all transplant surgery done today, including heart, lung and kidney, corneal transplants are the most common and
most successful.
What Conditions May Cause the Need for a Corneal Transplant?
Corneal swelling whether hereditary (Fuch’s Endothelial Dystrophy) or post cataract surgery (Pseudophakic
Bullous Keratopathy).
Keratoconus, a steep curving of the cornea.
Scarring after infections, especially with
bacteria or herpes virus.
Rejection after a first corneal transplant.
Scarring after injury.
What Happens If You Decide to Have a Corneal
Transplant?
Before Surgery: Once Dr. Farah decides you need a corneal transplant, your name is put on the list at a US-based Eye
Bank. Usually the wait for a donor cornea is within 4-12 weeks. Before a cornea is released for transplant, the eye
bank tests the human donor for the viruses that cause hepatitis and AIDS. The cornea is carefully checked for clarity.
Dr. Farah may request that you have a physical examination and other eye and blood tests. If you usually take
medications, ask your doctor if you should continue using them. You will also be given a prescription for an antibiotic
eye drop which you should use five times a day in the surgical eye starting one day before surgery.
The Day of Surgery: Surgery is often done on an outpatient basis. You will be asked to skip breakfast. Once you
arrive for surgery, you will be given eye-drops and a sedative to help you relax. Either local or general anesthesia is
used, depending on your age, medical condition and eye disease. You will not see the surgery while it is happening.
The Operation: Using the microscope the cornea is measured for the transplant. The recipient cornea is carefully
removed from the eye. Any necessary additional
work within the eye, such as removal of a cataract,
is completed. Then the clear donor cornea is sewn
into place using tiny stitches. The surgery itself
takes about 1.5 hour. When the operation is over,
Dr. Farah will usually place a shield over your eye.
After Surgery: You will go home after a short stay
in the recovery room. You should plan to have someone drive you home. An examination at the doctor’s office will
be scheduled for the following day.
You will need to:
Use the eye-drops as prescribed, and bring them with you to each clinic visit
Be careful not to rub or press on your eye
Continue normal daily activities but avoid strenuous exercise for 3 months
Wear eyeglasses or an eye shield for protection
To administer your eye-drops, lie down or tilt your head back, and put the drop in the inner angle of the eye without
touching your eyelids. Blink few times before wiping away any excess. Wait one to two minutes between drops to
prevent washing one out with the other.
Dr. Farah will decide when to remove the stitches, depending on the health of your
eye and rate of healing. Usually, it will be one year before all the stitches are
removed.
What Complications Can Occur?
Corneal transplants are rejected around 10% of the time. The rejected cornea becomes cloudy and vision
deteriorates.
Most rejections, if treated promptly, can be stopped. Warning signs of rejection are:
Persistent discomfort
Light sensitivity
Redness
Change in vision
Any of these symptoms should be reported to Dr. Farah immediately. The best way to avoid rejection is to use your
medication eye drops as prescribed.
Other possible side-effects include:
Infection
Bleeding
Swelling or detachment of the retina
Glaucoma
All of these complications can be treated. A corneal transplant can be repeated, usually with good results, but the
overall rejection rates for repeated transplants are higher than for the first transplant.
The irregular curvature of the transplanted cornea (Astigmatism) may slow the return of vision, and will probably
result in the need for a contact lens after surgery to achieve the best possible vision. Some patients may achieve
good vision after surgery with glasses. Vision may continue to improve up to a year after surgery.
Even if the surgery is successful, other existing eye conditions, such as macular degeneration, glaucoma or diabetic
retinopathy, may limit vision after surgery. Even with such problems, a corneal transplant may still be worthwhile.
A successful corneal transplant requires committed care and attention by you and your ophthalmologist for at least a
year after surgery, during which there will be many visits to your ophthalmologist, a need for frequent medication
eye drops, and slow visual recovery.
Are there any alternatives to corneal transplantation?
Yes. Some diseases that only affect the surface of the cornea can be treated with laser. This operation is
called phototherapeutic keratectomy (PTK).
Other diseases that affect the shape of the cornea can be treated with IntraCorneal Ring Segments and Corneal
Cross-Linking.