CORNEAL TRANSPLANTS - KERATOCONUS TREATMENT

In severe cases, a corneal transplant may be needed due to scarring, extreme thinning or contact lens intolerance. Lens intolerance occurs when the steepened, irregular cornea can no longer be fitted with a contact lens, or the patient cannot tolerate the lens. This is a surgical procedure that replaces the keratoconus cornea with healthy donor tissue. A successful corneal transplant results in a gradual improvement in vision. There is often useful vision within a few weeks. However, in some cases, it may take several months to a year for full vision to develop.

The corneal transplant surgery is generally performed on an outpatient basis. Most patients enter the hospital or surgery centre a few hours prior to surgery and leave that same day.

Steps of the Procedure

Step 1: A circular instrument, called a trephine, is used to remove the center of the diseased cornea.

Step 2: A "button" of similar size is cut from the donor cornea.

Step 3: This donor tissue is sewn in place with very fine sutures.

After the Procedure

Patients are given a patch and shield to protect the eye following the corneal transplant.

Typically there is only slight soreness for a few days after the surgery. This is usually relieved by over the counter pain medication such as acetaminophen.

It is important to protect the eye from any kind of eye trauma, including accidental bumps or pokes. It is usually recommend that patients wear glasses during the day and a shield at night for several months after the procedure.

The transplant heals relatively slowly because the cornea has no blood supply. Sutures are left in place for three months to one year. Often sutures are adjusted or loosened to improve vision. Suture adjustment and removal are simple, painless procedures. If the vision is good with the sutures in place, they may be left in permanently.

For several months after surgery it's important to use steroid eye drops to prevent rejection of the new cornea. In some cases, low dosage steroid drops are continued indefinitely. Unlike oral steroids, steroid eye drops cause no side effects elsewhere in the body. Occasionally other eye medications are necessary.

Unusual symptoms, including redness, sensitivity to lights, vision loss, pain, flashing lights, floaters, and loss of peripheral vision should be reported immediately.

Postoperative care is extremely important and by far the most time-consuming part of having a corneal transplant. The eye is checked the day after surgery, several times in the first month, at gradually longer intervals over the first year and usually annually thereafter.

With proper care and prompt attention to any sign of rejection the graft will remain clear and healthy over the lifetime of the patient.