A cornea transplant, also called keratoplasty, is a surgical procedure in which the central portion of a patient’s cornea is replaced with tissue from a donor cornea. The cornea, the clear tissue at the front of the eye, works with the lens inside the eye to refract incoming light. For most people, the cornea helps provide good vision throughout life, though some people may need spectacles, contact lenses, or refractive surgery in order to sharpen that vision. However, physical injury to the cornea, certain infectious diseases, and degenerative conditions such as keratoconus can leave the cornea scarred, damaged, or less than perfectly clear. In such cases, a cornea transplant becomes necessary in order to restore good vision. Cornea transplantation is the most commonly performed tissue transplant in the world.
There are several types of cornea transplants available to treat a variety of cornea conditions. The board-certified cornea specialists at Hoopes Vision are experienced at all of these variations and can recommend the type of transplant that is likely to provide the best result for each individual patient.
Penetrating Keratoplasty (PK) is the oldest type of cornea transplant procedure and is still the one most commonly performed today. In a PK procedure, the patient’s damaged or diseased central cornea is removed by the surgeon. The surgeon then puts a similarly-sized piece of a donor cornea in its place, securing it with sutures. At the hands of a trained, experienced surgeon, PK is a safe, predictable procedure with a high probability of restoring good vision.
Descemet’s Stripping Automated Endothelial Keratoplasty
Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) is a relatively new procedure, part of a family of newer transplant procedures known collectively as partial-thickness transplants. Whereas in PK all five layers of the cornea are removed and replaced – a full-thickness transplant – in DSAEK only the innermost layer, the endothelial layer, is replaced. Compared to PK, DSAEK requires fewer sutures and has a faster recovery time and lower incidence of tissue rejection. DSAEK can be a good option for patients with conditions such as Fuch’s Dystrophy, which affect only the endothelial layer.
Deep Anterior Lamellar Keratoplasty
Deep Anterior Lamellar Keratoplasty (DALK) is another partial-thickness transplant procedure. In a DALK surgery, the endothelial layer is left intact, and only the outer layers of the cornea are replaced with donor tissue. Compared to PK, DALK can give better postoperative vision and the risk of graft rejection is nearly zero. DALK can be a good option for certain patients with keratoconus. The newest development in this procedure is the advent of laser-assisted transplants, known as Femtosecond Laser Enhanced Deep Anterior Lamellar Keratoplasty (FLEDALK). In a FLEDALK procedure, a computer-guided laser is used to prepare the patient’s graft site as well as to shape the donor tissue, leading to a better fit and stronger graft.
FREQUENTLY ASKED QUESTIONS
Here are some of the most frequently asked questions to help you understand how this life-changing surgery can help improve your vision correction needs.
After surgery, it is normal to feel some stinging and discomfort, as well as the sensation of a foreign body in the eye. This discomfort is usually managed with over-the-counter acetaminophen. Severe pain after surgery is not normal.
Patients are typically in the operating room for about an hour and in the surgery center for a total of about two hours on the day of surgery.
Before leaving the surgery center, the operated eye will be covered with a plastic shield which you will be asked to wear until your follow-up appointment the next day. At that appointment, the doctor usually removes the shield and allows the eye to stay uncovered.
Most transplant procedures require sutures. How many sutures, and how long they must stay in before being removed by the surgeon, can vary with the patient and the type of transplant. Some sutures are removed in just a few months while others may need to stay in the eye for several years.
You will be prescribed several medicated eye drops for use after surgery. These will help prevent infection, speed healing, and reduce the risk of tissue rejection. Strict adherence to your postoperative drop schedule is one of the most important things you can do to ensure the success of your cornea transplant.
The surgeon and the post-op nurse will talk to you about restrictions on your activities after surgery. While you can return to most normal activities soon after surgery, you will be cautioned against lifting heavy objects, rubbing the operative eye, and engaging in activities where something may hit your eye for a certain time period.
Vision is usually blurry after surgery. It improves over time but can fluctuate as the graft heals. Therefore, the surgeon will monitor your vision for stability and may wait anywhere from three months to a year before giving you an updated eyeglass or contact lens prescription.
If the vision in your other eye is adequate for driving, you can drive the day after surgery since it can take that long for the anesthetic to wear off completely.
It depends on the nature of your work as well as your recovery. Patients with indoor office jobs and good vision in the non-operative eye can often return to work within a few days. Patients who work in dusty environments or whose work requires heavy lifting may be instructed to take several weeks off.
ICL, short for implantable collamer lenses, can be a good option for highly nearsighted patients who are not good candidates for laser vision correction. Hoopes Vision is one of the most experienced ICL practices in the United States.
The KAMRA corneal inlay is an exciting new procedure intended to help patients suffering from presbyopia, the gradual loss of near vision that happens to most people starting in their 40s. KAMRA can reduce or eliminate the need for reading glasses without affecting distance vision.
Intacs corneal rings are an excellent option for many patients suffering from keratoconus. They can lend stability to the cornea, slowing or halting the disease’s progression and making contact lens use possible.
I want to thank each staff member that I encountered at Hoopes Vision as I went through the process. Your dedication to skill, accuracy and the patient’s comfort are second to none.Brendan White, ODOptometrist
Don’t skimp on your eyes. You may find somewhere cheaper, but if a complication arises, you will have the rest of your life to wish you had just gotten the best. Hoopes is number one for a reason.Patrick RomeroOutdoors Enthusiast, Videographer
Thank you, Hoopes, for making my experience one that was comfortable and rewarding. I highly recommend everyone to go to Hoopes; I refer all of my clients to Hoopes Vision.Shelly BohmanPermanent Cosmetics of Utah