Corneal transplant procedures may restore vision to otherwise blind eyes in some cases. There are many conditions in which corneal transplantation may be considered. Indications include corneal ulceration, corneal scars, keratoconus, herpes simplex and Varicella zoster viral infections leading to scarring, Fuch’s endothelial dystrophy, congenital opacities of the cornea, and chemical burns of the eye.
The Corneal Transplantation Procedure:
- A complete pre-operative evaluation will be required prior to surgery. The surgeon will make every attempt to confirm retinal and optic nerve function prior to surgery, so as to avoid cases in which visual improvement is unlikely.
- The majority of adult patients may be operated on under local anesthesia. General anesthesia will likely be required for children, anxious, or uncooperative patients. After the anesthetic is given, the surgeon usually sews a ring to the ocular surface to support the eye. The donor cornea is prepared using a punch or corneal trephine to create the corneal “button.” The corneal button will become the transplanted cornea. The diseased, or scarred, cornea is then removed using a corneal trephine, creating a “bed” for the transplant cornea. Finally, the donor cornea is gently sewn into place with ultra-fine sutures (approx. one-third the thickness of human hair, or less).
- Corneal transplantation may be combined with other procedures, particularly cataract extraction with intraocular lens implantation.
- Postoperatively, patients should expect very gradual recovery of vision. In fact, the best vision may not be obtained for six to twelve months or more following surgery, even though vision may be improved from the first day after surgery in some cases. The surgeon will likely begin to remove some sutures from the cornea within a few weeks to a few months after surgery. However, all of the sutures need not be removed. In general, sutures are removed to help alleviate astigmatism once the cornea begins to show signs of being securely healed into place.