Cornea Transplant Surgery

Corneal Transplant Surgery Overview

Corneal transplant surgery is medically referred to as a form of keratoplasty. It involves removing diseased corneal tissue or a damaged cornea and replacing it with donor corneal tissue. 

The cornea is vital to your ability to see. It allows light to enter into the eye.

More than 47,000 corneal transplant surgeries are performed each year in the United States alone. Many of them have proven quite successful with only a tiny risk of transplant rejection.¹

Who Needs Cornea Transplant Surgery?

You may require corneal transplant surgery if you have a damaged cornea that is causing blurred vision, cloudy vision, or eye pain.  

You may also need a corneal transplant if you have one or more of the following medical diagnoses:

Fuch’s dystrophy

This condition results in swelling of the cornea and blurred vision. Both are caused by the endothelial cells of the cornea dying or becoming dysfunctional.

Keratoconus

A normal, healthy cornea is dome-shaped. However, those with keratoconus have a thin, cone-shaped cornea.

Bullous keratopathy

This condition causes blurred vision, eye pain, and eye discomfort from a blister-like swelling in the cornea.

Keratitis

Bacteria, fungi, or parasites cause inflammation of the cornea with keratitis.

Infection

Inflammation or infection of the eye can lead to cornea scarring, causing an inability to see clearly.

Traumatic injury or penetrating injury

Ocular trauma may necessitate corneal transplantation.

Types of Corneal Transplants

There are three main types of corneal transplants:

1. Endothelial Keratoplasty

If you have a damaged endothelium, the cornea’s innermost layer, you may benefit from endothelial keratoplasty corneal transplantation surgery. 

There are two common types of endothelial keratoplasty:

1. Descemet stripping automated endothelial keratoplasty
2. Descemet membrane endothelial keratoplasty

How it Works

During this cornea transplant procedure, an eye doctor (ophthalmologist) removes the damaged innermost tissue, the endothelial tissue, and provides a graft to replace it with healthy donor tissue. 

Rather than using several stitches, your doctor uses a small air bubble to maintain the placement of the donor tissue.

Side Effects

Although this donor cornea procedure bears a relatively low risk, possible side effects include:

• Bleeding
• Infection
• Glaucoma
• Retinal detachment
• Tissue rejection

Cost

Endothelial keratoplasty, more specifically Descemet's stripping endothelial keratoplasty, or DSAEK, costs a little more than $9,300.² Though this type of corneal transplantation is quite costly, it is less expensive than other donor cornea transplant surgeries.

2. Penetrating Keratoplasty

Penetrating keratoplasty is also known as a full thickness cornea transplant. It is ideal if you have a significant corneal injury and need all layers of your cornea replaced.

How it Works

When the small, dome-shaped part of the eye (cornea) becomes wholly damaged, an eye doctor may recommend this surgery. First, the surgeon carefully removes the cornea with a scalpel. Then they replace and attach all layers with fragile, hair-like stitches.

Side Effects

This surgery has a longer recovery time and more risks than others. These include:

• Endophthalmitis
• Endothelial failure
• Glaucoma
• Microbial keratitis
• Wound leaking
• Tissue rejection

Cost

Penetrating keratoplasty costs approximately $10,239. However, this procedure requires the replacement of far more tissue than those mentioned above.³

3. Anterior Lamellar Keratoplasty (ALK)

If you have keratoconus, or a bulging cornea, you may benefit from deep anterior lamellar keratoplasty (DALK). This is also referred to as a partial thickness corneal transplant. 

This surgery treats damage to the front and middle layers of the cornea and restores healthy corneal tissue. 

How it Works

In anterior lamellar keratoplasty, a surgeon dissects the cornea into two small pieces to easily remove the damaged front and central areas. Through tedious stitching, they remove and attach healthy donor corneal tissue in place of the damaged tissue.

Side Effects

Compared to penetrating keratoplasty, DALK cornea transplants offer significant safety advantages. This is because far less of the eye is opened or exposed during surgery. 

A few complications include:

• Incomplete attachment of Descemet’s membrane
• Opacification of the interface between the posterior corneal stroma and Descemet’s membrane
• Infection

Cost

Anterior lamellar keratoplasty corneal transplantation costs nearly $9,042.⁴

What to Expect Before Surgery

In the days to weeks before your corneal transplant, you will meet with the ophthalmologist to discuss your surgery. They will: 

1. Conduct a physical examination
2. Go over your medical history
3. Talk about your damaged or diseased cornea
4. Answer any questions that may arise

Your surgeon will also order routine lab work to ensure no underlying medical conditions go unnoticed. 

Alert your surgeon about any prescription and/or over-the-counter (OTC) medications you are currently taking. You must also discontinue certain medications, such as blood thinners, before the procedure.

Once you and your doctor have decided to move forward with a medical procedure, you will set a surgery date. Your surgeon may need to change your operation date if there is no compatible, healthy donor tissue at the time. 

In addition, your doctor will give you antibiotic eye drops the day before the surgery. This is to reduce the risk of postoperative infections.

Corneal transplant surgery is an outpatient procedure. This means you will not need to stay the night in the hospital. Make transportation arrangements before your procedure because you cannot drive on the day of surgery.

The Day of Surgery

On the day of the corneal transplant procedure, you will arrive at the designated facility and ensure all necessary paperwork is filled out and signed. 

Just before your surgery commences, your doctor will place numbing drops into your eye. They may also give you medication to help you relax. 

You are then placed under sedation or general anesthesia to ensure you do not move or feel pain during the surgery. Your surgeon will put a device into place to hold your eye open throughout the procedure.

If you are experiencing other eye problems, such as cataracts, your ophthalmologist might repair these conditions alongside the new cornea transplant.⁵

What to Expect After Surgery

Upon successful completion of the corneal transplant, your ophthalmologist will tape a shield or patch over your eye. You will wear this patch for 1 to 4 days post-op. This ensures your eye is safely covered and reduces the risk of infection. 

When the procedure is over, medical personnel will move you to a recovery room. A highly skilled team of professionals will closely monitor you as you wake from anesthesia. 

Once deemed safe, you will be allowed to return home to rest and recover. A family member or friend will have to drive you home.

Your physician will prescribe eye drops, which you should use as directed to reduce inflammation and prevent infection. You will also take pain medication as needed to reduce eye pain.  

Until the cornea heals, you will likely experience: 

• Some redness to the affected eye
• Sensitivity to light
• Discomfort or pain

You should be able to drive 24 hours after your transplant. Your doctor will tell you when you can return to work. This may be a few days or weeks following your procedure.  

If your job requires strenuous activities, you may need more time off of work. Your doctor will inform you to avoid any activities that can result in a direct hit to the eye. 

Contact Lenses After Surgery

Following keratoplasty, you may need contact lenses for vision or preference reasons.⁶ Contact lenses can correct:

• Irregular astigmatism
• High regular astigmatism
• High anisometropia
• Secondary aniseikonia
• Simple ametropia

You might also prefer to wear contact lenses over eyeglasses. Typically, you will not need special types of contact lenses, such as rigid gas permeable lenses, after endothelial transplants. However, you may need these types of contact lenses following penetrating keratoplasty or deep anterior lamellar keratoplasty surgery.⁷

A full recovery following cornea transplant surgery can take upwards of one year, if not longer. You can expect blurred vision in the days, weeks, and months following surgery.

What are the Risks of Corneal Transplants?

Many corneal transplant surgeries performed in the United States are successful. But there are a few risks associated with these types of procedures, including:

• Bleeding
• Infection
• Glaucoma
• Retinal detachment
• Cornea detachment
• Fluid leakage from the cornea
• Vision acuity issues, such as vision sharpness

What is the Prognosis of Corneal Transplants?

The prognosis for cornea transplants depends on many factors, including: 

• The exact cause of cornea damage
• The type of surgical technique your surgeon uses
• Your immune system’s acceptance of the donor cornea transplant

Because there are so many prognostic factors, discuss your post-op outlook one-on-one with your ophthalmologist before surgery. 

Full vision can take up to one year to return as cornea transplants are invasive procedures. You may experience swelling, inflammation, and sensitivity to light as your eye recovers and heals.⁹  

Many people who receive corneal transplants experience good vision for years to come, especially when they closely follow all post-op instructions. 

If you have any concerns regarding your vision following your cornea transplant surgery, reach out to your ophthalmologist as soon as possible.