What is a corneal transplant?
A corneal transplant refers to the replacement of all or parts of the cornea with a donor cornea.
Why do you need a corneal transplant?
The cornea is a clear transparent window at the front of your eyeball. It allows light to enter the eye and provides focus so that a clear image can be seen. A variety of diseases or injury can affect the cornea, causing it to become cloudy or out of shape. This prevents the normal passage of light into the eye, thus affecting vision.
A cloudy or diseased cornea can be replaced with a healthy cornea from a donor to restore vision.
What are the various types of corneal transplants?
The principle of modern corneal transplantation is to replace only the layer of the cornea that is affected, allowing us to preserve the healthy parts of the cornea that are unaffected by the disease process. The cornea has 3 main layers – a thin outer and inner layer and a thick middle layer. Depending on the underlying problem, we can now transplant only the outer and middle layers, only the inner layer, or if needed, the entire cornea.
Types of corneal transplants
Deep Anterior Lamellar Keratoplasty (DALK)
In some diseases, only the middle layer of the cornea is affected. In these eyes, the outer two layers of the cornea are removed and replaced with the outer two layers from a donor cornea. This is known as a Deep Anterior Lamellar Keratoplasty (DALK). This partial thickness transplant preserves the inner layer of your cornea, which gives it greater structural integrity and reduces your risk of graft rejection.
Keratoconus is the most common condition requiring a DALK. Others include corneal scars and some corneal dystrophies.
Endothelial Keratoplasty (EK)
Also known as Descemet’s Membrane Endothelial Keratoplasty (DMEK), or Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK)
In some diseases, only the inner layer of the cornea is affected, causing corneal oedema (swelling and clouding). In an Endothelial Keratoplasty (DMEK or DSAEK), this inner layer is removed and replaced with the inner layer from a donor cornea. This partial thickness transplant preserves the shape of the front surface of your cornea and recovery is much quicker compared with a conventional full-thickness corneal transplant.
Fuch’s endothelial dystrophy and pseudophakic bullous keratopathy (corneal decompensation after cataract surgery) are the two main indications for an EK.
Penetrating Keratoplasty (PK)
If the full thickness of the cornea is affected by disease, all three layers of the cornea are removed and replaced with a full-thickness donor cornea. This full-thickness corneal transplant is known as a Penetrating Keratoplasty (PK).
What happens during corneal transplant surgery?
Corneal transplant surgery is usually performed as a day surgery. The procedure takes approximately 1 to 2 hours depending on the type of corneal transplantation performed and whether the procedure is combined with another procedure, which is usually cataract surgery.
The procedure can be performed under local or general anaesthetic, depending on the type of transplant performed and your personal preference.
The diseased layer(s) of the host cornea is removed first, and then the corresponding layer(s) of the donor cornea is transplanted onto the recipient’s eye and sutured in place, or in the case of endothelial keratoplasties, the transplant is held in place with an air bubble in the eye.
What can I expect after a corneal transplant?
You will be reviewed by ophthalmologist and corneal specialist Dr Goh after the surgery and can usually go home on the same day. We recommend that you have someone with you to drive you home. You will be reviewed again 1 day and 1 week after surgery, and thereafter as advised by Dr Goh. You will typically have 6 follow-up appointments in your first year following a corneal transplant.
You will be given antibiotic and anti-inflammatory drops to prevent infection and assist with healing. The antibiotic drops are usually given for 7 days and the anti-inflammatory drops are used for a much longer period of time to reduce your risk of graft rejection.
How quickly will my vision recover after a corneal transplant?
Visual recovery depends on the type of corneal transplant performed, with patients undergoing partial thickness transplants experiencing faster recovery. At your consultation, Dr Goh will discuss in detail what to expect during the recovery process.
Booking a consultation
If you’re looking for a corneal specialist in Melbourne and would like to find out more about whether corneal transplants are suitable for you, please contact us on (03) 9070 0955 to book a consultation with Dr Joanne Goh. Or click on the button below to request a call back.