Corneal Transplantation

What is corneal transplantation?

Corneal transplantation is a surgery that replaces your poorly functioning cornea with a new donated one.

The cornea is your eye’s outermost layer. It is a clear layer that caps the front of your eye. It helps protect the rest of your eye from germs and debris. It also helps focus light into your eye. Different medical problems can damage your cornea. They can make it cloudy and opaque or distort its shape. If this happens, your vision can be damaged. In some cases, it can even lead to blindness.

The most common form of corneal transplantation is called penetrating keratoplasty. Your surgeon removes the central part of your damaged cornea. He or she replaces it with a clear cornea from a cadaver donor. Your surgeon then sews this new cornea into your eye. Less commonly, eye surgeons replace only the damaged layer of your cornea. In the U.S., surgeons perform corneal transplantation frequently.

Why might I need corneal transplantation?

If you have scarring or damage to your cornea, your vision can be damaged. Your eye doctor may need to treat the underlying cause of the damage to your cornea. If the damage is severe enough, you might also need corneal transplantation to repair your sight. Conditions that might require corneal transplantation include:

  • Bullous keratopathy
  • Complications from cataract surgery
  • Corneal dystrophy
  • Corneal scar
  • Corneal swelling
  • Infection of the cornea
  • Injury
  • Keratitis
  • Keratoconus

If the damage to your cornea is minor, it may heal on its own without the need for transplantation. If you have a very badly damaged cornea, phototherapeutic keratectomy may be another option. This method uses a laser to etch away part of your damaged cornea. However, this method is not right for all types of cornea damage.

If you need corneal transplantation, ask your eye doctor whether a full-thickness or partial-thickness transplantation would be best for you. Talk with him or her about the treatment that makes the most sense for you.

What are the risks of corneal transplantation?

Corneal transplantation has a fairly high success rate. However, sometimes complications do happen and may include:

  • Bleeding in the eye
  • Cataracts
  • Corneal infection
  • Detachment of the new cornea
  • Eye inflammation
  • New refractive errors, requiring glasses or contact lenses
  • Worsening of glaucoma
  • Severe infection inside the eye (endophthalmitis)
  • Severe infections on the surface of the eye (eye ulcer or abscess)
  • Retinal detachment

There is also a risk that the surgery will not work and that you will have impaired vision.

Another major possible complication is rejection of the donated cornea. Your immune system might recognize that the tissue is foreign and mount an immune response. This can cause the transplant to fail. If this happens, you will probably need another corneal transplantation. To minimize your risk of vision loss from rejection, ask your eye doctor what the signs and symptoms of rejection are. If you experience any of these symptoms, see your eye doctor right away. Early treatment may prevent loss of vision.

Your risk for complications may differ based on your age, your other medical conditions, and the reason for your corneal transplantation. Ask your eye doctor about your own risks for corneal transplantation.

How do I prepare for corneal transplantation?

Ask your eye doctor what you need to do to prepare for corneal transplantation. Ask whether you need to stop taking any medicines before the procedure. You will need to avoid eating anything after midnight before the day of the procedure.

Your eye doctor may want to use special instruments to shine a light in your eye and examine your cornea. You may need to have your eyes dilated for this eye exam. You also might need computerized corneal mapping. This will give your eye doctor even more information about your cornea.

What happens during corneal transplantation?

Talk with your eye surgeon about what will happen during your surgery. The details may vary. In general, during the procedure:

  • You may receive anesthesia to put you to sleep. If this is the case, you will sleep deeply through the surgery and won’t remember it afterwards.
  • In other cases, you may be awake during the surgery. You will receive a medicine to help you relax. In this case, your healthcare provider may use anesthetic eye drops and injections to make sure you don’t feel anything.
  • Your surgeon will remove the central portion of your damaged cornea.
  • Your surgeon often uses a very fine thread to sew the new donated cornea in place. Sometimes, your surgeon will place an air bubble inside your eye to keep the new tissue in place, instead of sutures or thread.
  • An antibiotic ointment may be applied to your eye to help prevent infection.
  • Your eye will be patched and covered.

After the Test

Ask your eye doctor about what you should expect after your surgery. In most cases, you will be able to go home the same day. Plan to have someone go home with you after the procedure.

Be sure to follow your eye doctor’s instructions about eye care and medicines. You may need to take antibiotic eye drops to help prevent infection. Your eye may be a little sore after the procedure, but you should be able to take over-the-counter pain medicines. You may need to wear an eye patch for a day or so. You will also need to take medicines to prevent rejection of your new cornea. Ask your eye doctor whether you should avoid any specific activities as you recover. Avoid rubbing your eyes.

You will need close follow-up care so your eye doctor can see whether the procedure was effective. You may have a scheduled appointment the day after the procedure. Your stitches may be removed at a follow-up visit, but this might not be until much later.

Tell your eye doctor right away if you have any signs of complications, including rejection. These might include symptoms like:

  • Decreased vision
  • Increased eye pain
  • Increased eye redness
  • Increased sensitivity to light

You may not be able to see well right away because of eye swelling. Fortunately, most people who have corneal transplantation will go on to have good vision for many years.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure

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