Cornea Transplant

What does it involve?

A cornea transplant is a surgical treatment used to treat changes in transparency or morphology of the cornea.

Which patients and diseases are suitable for such treatment?

A cornea transplant is mainly practised in those cases with a loss of corneal transparency. Some of the most common causes include: Anterior or posterior corneal dystrophies (Fuchs' endothelial dystrophy), infectious diseases, such as bacterial keratitis or herpes simplex keratitis, inflammatory corneal ulcers, thermal or chemical burns, corneal trauma.

A cornea transplant is also practised in those cases with a change in corneal morphology. Corneal ectatic disorders, such as keratoconus or pellucid marginal degeneration.

What is the technical procedure like?

There are different types of transplant depending on which layer of the cornea is affected. The procedure can be full-thickness, affecting all its layers, or lamellar, when only part of the corneal structure is transplanted.

Full-thickness transplant: when all layers of the cornea are affected

Anterior lamellar transplant: when only the most superficial (surface) layers of the cornea are affected

Lamellar endothelial transplant: DSAEK. When the innermost layer of the cornea is affected

Is there any major risk?

The main risks in a corneal transplant are: infection or bleeding (as with any type of ophthalmic surgery) and rejection (only in the case of full-thickness transplant or lamellar endothelial transplant).

Is it a good idea to have any tests done before the operation?

The cornea is a non-vascular tissue and therefore the risk of rejection is very low. No compatibility tests or matching of the patient and the corneal tissue to be implanted are required.

However, the usual pre-op study for any operation must include serum antibody testing for infections such as: HIV, hepatitis, syphilis.

What is the post-operative period like?

Cornea transplants are performed as day (outpatient) surgery, i.e. with no stay in hospital.  Post-operative care following full-thickness transplant or anterior lamellar transplant surgery requires modified bed rest for approximately the first 5 days.

Endothelial transplant requires complete bed rest, lying face up for 24 hours, to guarantee correct positioning of the transplanted corneal graft. This is because an air bubble holds the endotelial flap of the corneal graft in place until it has finally adhered.

What are the possible outcomes?

The outcomes of corneal transplant are very good, resulting in restored transparency and visual function in most cases.

In full-thickness or anterior lamellar transplant, which require numerous stitches, visual recovery is susceptible to suture-related post-operative astigmatism and therefore optimum vision is sometimes not achieved for up to 9 months after the operation. In the case of endothelial transplants, visual recovery is faster, with optimum vision achieved in approximately 1-2 months.