Cornea transplant or keratoplasty, is a surgical procedure involving replacement of part of the diseased or damaged cornea with corneal tissue from a donor. The cornea is the transparent, front part of the eye. It lets light enter enabling the eye to see clearly. The procedure can restore vision, reduce pain and improve the appearance of an impaired cornea.
Fortis Hospitals, Mumbai Ophthalmology Department offers state-of-the-art techniques for careful evaluation, diagnosis and treatment of multiple conditions that may distort or cloud the normally transparent cornea including rare sight-threatening corneal disorders. Our skilled surgeons have extensive experience in performing full thickness and partial thickness corneal transplants. We are the leading centre for highly advanced corneal surgeries, such as suture-less corneal transplants (DSEK, DMEK).
Department utilises a collaborative approach to bring holistic care to patients with the best surgical outcomes, at par with international standards. Our constant endeavour is to deliver a patient-friendly ecosystem by enabling smooth transition post-surgery and a faster return to daily routine.
A cornea transplant is usually performed to restore vision in a person with a damaged cornea. The surgery can also relieve pain and symptoms associated with cornea diseases. Conditions that may be treated with a cornea transplant include:
Complications caused from previous cataract or another eye surgery
Corneal dystrophy (a hereditary condition)
Corneal scarring, caused by infection or injury
Corneal swelling
Corneal ulcers not responding to medical treatment
Keratoconus (cornea that bulges outward)
Thinning or tearing of the cornea
A cornea transplant involves removing either entire or part of the diseased cornea, replacing it with healthy donor tissue. The eye surgeon will discuss the method best suited to the patient. The types of procedures include:
Penetrating Keratoplasty (PK) - a full thickness cornea transplant, involves replacing the entire cornea with a healthy donor cornea.
Endothelial Keratoplasty (EK) - involves replacing the inner layer of the cornea with a healthy inner layer of the donor cornea. There are two types of EK.
Descemet Stripping Endothelial Keratoplasty (DSEK), uses donor tissue to replace about one-third of the cornea.
Descemet Membrane Endothelial Keratoplasty (DMEK), uses a much thinner layer of donor tissue.
Anterior Lamellar Keratoplasty (ALK) - involves replacing the outer layer of the cornea with a healthy inner layer of donor cornea.
Superficial anterior lamellar keratoplasty (SALK) replaces only the front layers of the cornea, leaving the healthy stroma and endothelium intact.
Deep anterior lamellar transplant (DALK) is used when cornea damage extends deeper into the stroma. Healthy donor tissue is then attached to replace the removed portion.
Artificial cornea transplant (Keratoprosthesis) - involves replacing the entire cornea with an artificial cornea. This procedure is used when the cornea is so severely damaged that it cannot be replaced with a natural donor cornea.
Most cornea transplant procedures are successful; however, it still carries a small risk of complications. The risks are based on multiple factors such as patient’s age, pre-existing health conditions and original reason for the transplant. The risks include:
Bleeding in the eye
Eye infection
Detachment of the new cornea
Pressure increase within the eyeball (glaucoma)
Rejection of the donor cornea
Retinal detachment or swelling
The body’s immune system may mistakenly recognise the new tissue as foreign and attack the donor cornea. This is called donor rejection. The risk may range from low to high, depending on various factors. Immediate medical treatment may be required in case of signs and symptoms, such as:
Eye pain
Red eyes
Sensitivity to light
Vision loss
Unlike with other organs such as liver, kidneys, people requiring corneal transplants do not require tissue matching. Corneas used in corneal transplants are from deceased donors. Corneas of people who have died from unknown causes or conditions in which the infection can spread are not considered for the transplant. Donor corneas are widely available and usually the waiting list is not very long. Many corneal transplants are conducted across India.
Patient may undergo the following steps before the cornea transplant surgery:
Eye examination by the eye doctor (Ophthalmologist)
Eye measurements - to determine the size of donor cornea needed
A review of all medications and supplements patient is taking - certain medications or supplements may need to be stopped before or after the cornea transplant.
Treatment for other eye problems - unrelated eye problems, such as infection or inflammation may reduce the chances of a successful cornea transplant, the doctor will treat those problems before the surgery.
Blood tests (including exposure to Hepatitis and HIV)
Heart test (EKG)
X-ray
Based on the patient’s clinical condition, the doctor will discuss the preferred mode of treatment along with the associated risks and benefits.
On the day of the cornea transplant, anaesthesia team will administer either a sedative or local anaesthetic to numb the eye or general anaesthesia to put the patient to sleep, depending on the discussed surgical plan. Surgery is done on one eye at a time. The amount of time spent in surgery is different and depends on the patient’s situation.
Once the cornea transplant is completed, patients may be expected to:
Receive medications - post the procedure and during recovery, to help control eye infection, swelling and pain, doctor may recommend eyedrops and oral medications. Eyedrops suppress the immune system help prevent cornea rejections.
Wear eye protection - eye patch or glasses to protect the eye as it heals.
Lie on the back - depending on the type of transplant. To be done for a while after surgery, to help the new tissue stay in place.
Avoid injury - take it easy after the transplant and slowly return to normal activities, including exercise. Do not rub or press on the eye, this will interfere with the healing process.
Return for frequent follow-up examinations - in the year after surgery to monitor progress and assess complications.
The surgical result depends on various factors such as reason for the surgery and the patient’s health.
Initially vision may be worse post-surgery compared to before the surgery. It may several months before vision improves, as the eye keeps adjusting to the new cornea.
Vision correction post-surgery
Once the outer layer of the cornea has healed, after several weeks or months post-surgery, the ophthalmologist will work to make adjustments to improve the vision, such as:
Correcting unevenness in the cornea (astigmatism) - the stitches that hold the donor cornea in place on the eye might cause dips and bumps in the patient’s cornea, causing blurry/spotty vision. This may be corrected by releasing some stitches and tightening others.
Correcting vision problems - refractive errors, such as near sightedness and far sightedness can be corrected with glasses, contact lenses or at times with laser eye surgery.
