What is a Corneal Transplant?
A corneal transplant, also known as
keratoplasty, is a surgical procedure
to replace a damaged or diseased
cornea with healthy donor tissue.
The cornea, the clear, dome-shaped
outer surface of the eye, plays a
crucial role in focusing light for clear
vision. Damage or disease to the
cornea can lead to impaired vision,
pain, or complete blindness. Corneal
transplants restore vision, alleviate
pain, and improve the overall quality
of life for individuals affected by
corneal disorders.
Why is a Corneal Transplant Performed?
Corneal transplants are necessary when the cornea becomes scarred, swollen, or damaged,
hindering its ability to refract light properly. Common reasons include:
● Corneal Scarring: Due to infections like herpes simplex keratitis or trauma.
● Keratoconus: A progressive thinning and cone-like bulging of the cornea.
● Fuchs’ Endothelial Dystrophy: A degenerative disease affecting the inner corneal
layer.
● Corneal Edema: Swelling of the cornea, often following cataract surgery.
● Corneal Ulcers: Severe, non-healing ulcers that damage corneal tissue.
Types of Corneal Transplants
Corneal transplants can be classified based on the extent of tissue replaced:
1. Penetrating Keratoplasty (PK):
o A full-thickness transplant where the entire corneal layer is replaced.
o Commonly performed for severe scarring or damage.
2. Lamellar Keratoplasty:
o Replaces only the damaged layers of the cornea, preserving healthy tissue.
o Subtypes include:
▪ Anterior Lamellar Keratoplasty (ALK): Targets the front layers of
cornea. Eg; Femtosecond Laser-Assisted Keratoplasty (FALK), Deep
Anterior Lamellar Keratoplasty (DALK).
▪ Posterior Lamellar Keratoplasty (ALK): Targets the posterior layers
of cornea. Ex: Descemet’s Membrane Endothelial Keratoplasty
(DMEK) and Descemet's Stripping Automated Endothelial
Keratoplasty (DSAEK)
3. Keratoprosthesis:
o A synthetic cornea is used when a donor cornea is not viable.
The Procedure
1. Preoperative Evaluation:
o Comprehensive eye examination, including measurements of the corneal
curvature and thickness.
o Screening for infections or other underlying conditions.
2. Donor Cornea Preparation:
o Healthy corneal tissue is obtained from an eye bank and matched for
compatibility.
3. Surgical Steps:
o The damaged corneal tissue is carefully removed.
o The donor cornea is placed and secured with fine sutures or adhesive.
o Depending on the type of keratoplasty, only specific layers or the entire cornea
is replaced.
4. Postoperative Care:
o Antibiotic and anti-inflammatory eye drops are prescribed.
o Protective eye shields are used to prevent accidental injury.
Recovery and Aftercare
● Healing Time: Full recovery may take several months, though vision improvement is
noticeable within weeks.
● Suture Removal: Sutures, if used, are removed gradually based on healing progress.
● Follow-Up Visits: Regular follow-ups are essential to monitor for complications like
infection or rejection.
● Activity Restrictions: Avoid strenuous activities, rubbing the eyes, or exposing them
to dust and water.
Complications and Risks
While corneal transplants are generally safe, potential risks include:
● Rejection: The immune system may reject the donor tissue, causing redness,
sensitivity, and vision loss.
● Infections: Rare but possible if post-surgical care is inadequate.
● Astigmatism: Irregular corneal shape after surgery may require corrective lenses.
● Recurrence of Disease: Some underlying diseases like herpes keratitis may recur.
Key Takeaway
Corneal transplants are a transformative surgery for individuals with corneal diseases or
damage, offering improved vision and quality of life. With advancements in surgical
techniques and donor availability, this procedure is safe, effective, and widely accessible.
Proper care and regular follow-ups are crucial for long-term success.
