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Patient Journey

Cornea

What is a Keratoplasty?

This is an operation to replace all or part of the cornea, with a healthy cornea from a donor.
Corneal blindness is a major cause of global blindness, second only to cataract.

Where does the doner tissue come from?

The new cornea comes from a donor who has given permission for their corneas to be used after they have died. The tissue is thoroughly tested for diseases and infections to ensure it is healthy to use.

Indication for Keratoplasty

Optical indications - improving vision by replacing opaque or distorted host tissue with clear and regular tissue.

The most common indications are:

  • Pseudophakic bullous keratopathy.
  • Keratoconus.
  • Corneal degeneration.
  • Keratoglobus.
  • Corneal dystrophy (eg, Fuchs' endothelial dystrophy): these  form the bulk of the older patient group).
  • Scarring due to infection or trauma.

Tectonic indications - to preserve corneal integrity in cases of corneal stromal thinning, corneal perforation or descemetoceles (ulcers extending into the stroma and exposing Descemet's membrane).

Therapeutic indications - this is rare, to remove inflamed corneal tissue which is not responding to other treatments.

Cosmetic indications - where the cornea has a whitish or opaque hue due to scarring.

Corneal transplant rejection

A corneal transplant may be rejected by your immune system. This happens in 7-10 % of patients in the first two years after transplantation and can cause graft failure. It can often be reversed in 90% if antirejection medication is started promptly, but rejection remains a possibility in your lifetime.

Full-thickness transplant

This is called a penetrating keratoplasty (PK). It is for patients where a partialthickness transplant would not be appropriate. This operation involves removing a circular piece of the damaged cornea and replaced
with a circular piece of the donor cornea tissue. The donor tissue is held in place by a series of small stitches for at least a year. The operation is most commonly carried out under general anaesthetic. Most patients go
home the same day.

Partial-thickness transplants

This is an operation to transplant either the front or back portions of the cornea. It can offer a faster  recovery, higher success rate and lower risk of complications. However, this type of operation is not suitable for everyone.

Deep anterior lamellar keratoplasty (DALK)

This procedure is used for patients where the disease process affects only the front portion of the cornea. For example, patients with keratoconus or corneal scarring affecting the top layers of the cornea.

The benefit of this procedure is a lower risk of rejection compared with a full thickness transplant because the back layer of your original cornea remains . The survival of the graft with DALK is longer than with a penetrating keratoplasty.

Transplanting the back portion of the cornea

These procedures are used in patients where the disease affects only the cell layer at the back of the cornea. This could be due to a condition called Fuchs’ endothelial dystrophy or secondary to problems related to previous eye surgery. Unlike the other types of corneal transplant, the graft is held in place by a temporary air bubble rather than a series of stitches. This means you will be asked to lie flat on your back for several hours after the procedure and will be reviewed before being sent home. The visual recovery is quicker

After Corneal Transplant

Your eye will feel uncomfortable and look bloodshot and swollen but please be assured this will settle over a few weeks. However, we advise you to:

  • Take the rest of the week off work, especially if you have had a general anaesthetic
  • Do not rub your eye
  • Avoid strenuous exercise and heavy lifting during the first two weeks
  • Stay away from smoky or dusty environments
  • Avoid contact sports and swimming until you have had a discussion with your surgeon
  • Bath and shower as normal but don’t get water in your eye during the first two weeks
  • Wear the clear protective shield at night for the first two weeks
  • Avoid driving until you feel comfortable to do so. Check with your clinician that your vision is legal
    for driving before starting to do so