Keratoplasty

Corneal transplantation is one of the procedures that an ophthalmologist may use to replace the cornea (the transparent layer in front part of the eye) in the patient due to some eye problems. The surgery is based on obtaining a natural cornea from a donor through known eye banks, and then an appointment is made for the patient's corneal transplantation after reassuring the matching. 

Eye surgeries have developed significantly as ophthalmologist relies on laser techniques to replace the cornea, a technique that has given the patient a faster recovery period and less pain and complications.

The treatment period in the case of corneal transplant takes approximately 3 days in Jordan.

Ophthalmologist may resort to corneal transplantation for some patients due to some eye problems, such as:

• Keratoconus.
• Thinning of the cornea.
• The corneal swelling or clouding
• Scarring of the cornea due to injury or inflammation.
• Fuchs' dystrophy.
• Corneal ulceration.
• Corneal opacity due to eye scratching and inflammation.
• Prior operations in the eye such as LASIK and others.

Before the approval of corneal transplantation, the patient should undergo some of the examinations required by the ophthalmologist, including:

• A comprehensive examination of the eye, including an examination for some structures in the eye, fundoscopy and the pressure inside the eye.

Some patients may suffer from some complications after undergoing corneal transplantation, such as:

• Inflammation of the eye or swelling of the cornea.
• Rejection of the cornea.
• The increase in the incidence of glaucoma due to high pressure in the eyeball.

Corneal transplantation includes the following steps:

1. Obtaining cornea from a donor through known eye banks around the world, where it is delivered according to the appropriate specifications of the patient (the recipient) with a certificate showing all information, the sample is kept in a fluid nourishing the tissue and added antibiotics to preserve the cornea until use.
2. Preparation of the patient for the surgery of corneal transplant by stopping the intake of any medicines or dietary supplements and treating any inflammation that may be in the eye.
3. Anesthetization of the patient (general or local anesthetic).
4. Removing damaged part of the corneal tissues using either:

- Special surgical cutting tool called a trephine, to install the new cornea (from the donor) by special stitches.

- Femtolaser; this device replaces the damaged cornea with the new in a high microscopic resolution according to the thickness and the degree of opacity in the eye. It is characterized by the non-use of stitches to stabilize the new cornea, but it replaces that with a contact lens placed on the cornea.

The corneal transplant may take about an hour.

Corneal transplantation is a very successful surgery, but it is highly dependent on the patient and how much he cares of his new cornea. After corneal transplantation, the patient must take some tips in consideration to ensure good vision and make the procedure as successful as possible, the ophthalmologist advises his patient to follow several tips after the cornea transplant by not rubbing the eye and maintaining permanent cleanliness and avoid touching it by hand without sterilization, taking care of the cornea and avoiding any factors that may lead to injury.

The patient can return to his normal life in few days, but after the corneal transplant, the vision will gradually improve.

Laser-assisted corneal transplantation is characterized by rapid recovery and less astigmatism due to non-use of the stitches in corneal stabilization. In addition, the patient's rejection of donor cornea is very low, almost 1%. 

The patient can recover his vision again after one to two weeks after the laser process, while it may take up to 6 months after the traditional surgery of corneal transplantation.

In the traditional surgery of corneal transplantation, the patient needs to remove stitches after about 10 months to a year.

---------------------------------------------------------------------

Written by: Laila Adnan Al-Jundi

Medically reviewed by: Shami eye center, on February 18, 2020