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Transplant Surgeries


Corneal Transplant

Corneal Transplant Treatment in India 

Overview 

A corneal transplant, also known as Corneal Grafting is a surgical procedure to replace the diseased or damaged cornea with healthy corneal tissue from a donor. The cornea is a transparent, dome-shaped surface of the eye that accounts for a large part of the human eye's focusing power. 

A cornea transplant can reduce pain, restore vision, and improve the appearance of a diseased or damaged cornea. 

Why is a Corneal Transplant done? 

A corneal transplant is most often used to restore vision to a person who has a damaged or diseased cornea. It may also relieve pain or other symptoms and signs associated with diseases of the cornea. 

Conditions that can be treated with a cornea transplant are: 

  • A cornea that bulges outward (keratoconus)
  • Fuchs' dystrophy
  • Thinning of the cornea
  • Cornea scarring, caused by infection or injury
  • Clouding of the cornea
  • Swelling of the cornea
  • Corneal ulcers, including those caused by infection
  • Complications caused by previous eye surgery 

Corneal Transplant Procedure 

Before Surgery

  • A thorough eye exam: The eye doctor thoroughly looks for conditions that may cause complications after surgery.
  • Measurements of your eye: The eye doctor determines what size of donor cornea the patient needs.
  • A review of all supplements and medications the patient is taking: The doctor may advise the patient to stop taking certain supplements or medications before or after the cornea transplant.
  • Treatment for other eye problems: Unrelated eye problems, such as inflammation or infection, may reduce the chances of a successful cornea transplant. Firstly, the doctor will work to treat those problems before corneal transplant surgery. 

Finding a donor cornea

  • Most corneas that are used in cornea transplants come from deceased donors. Unlike other organ transplants kidney and liver, people needing cornea transplants generally will not need to wait for long. That's because of the reason that many people request for cornea donation after they die, so more corneas are available for transplantation.
  • Corneas may not be used from donors with conditions, such as some central nervous system conditions, infections, and prior eye surgeries, or from people who died from an unknown cause.

During the procedure

  • On the day of your cornea transplant, the patient will be given a sedative to help him/her relax and a local anesthetic to numb the eye. The patient won't be asleep during the surgery, but he/she will not feel any pain.
  • Penetrating keratoplasty is the most common type of procedure used for Corneal transplant. During this procedure, the surgeon cuts through the entire thickness of the diseased or abnormal cornea to remove a tiny button-sized disk of corneal tissue. An instrument trephine is used to make this accurate circular cut.
  • The donor cornea is cut to fit and placed in the opening. 
  • The surgeon then stitches the new cornea into place. 
  • In some cases, if the patient is not eligible for a cornea transplant from a donor cornea, surgeons may insert an artificial cornea That is known as keratoprosthesis.

Procedures to transplant a portion of the cornea

For many cornea problems, a full-thickness cornea transplant isn't always the best and most appropriate treatment. For such problems, other types of transplants may be used to remove only certain layers of corneal tissue, or tissue affected by the disease. These types of procedures include:

  • Endothelial keratoplasty (EK): This procedure removes the damaged or diseased tissue from the back corneal layers, including the endothelium, and Descemet membrane. Descemet is a thin layer of tissue that protects the endothelium from infection and injury. Then the donor tissue is implanted to replace the removed tissue.
    • There are two types of endothelial keratoplasty. The most common type, called DSEK (Descemet stripping endothelial keratoplasty), replace about one-third of the cornea with the donor tissue. 
    • A newer type of procedure, called DMEK (Descemet membrane endothelial keratoplasty), uses a much thinner layer of donor tissue. The tissue used in DMEK is extremely fragile and thin, so, this is more challenging than DSEK.
  • Anterior lamellar keratoplasty (ALK): Anterior lamellar keratoplasty removes diseased or damaged tissue from the front corneal layers, including the stroma and the epithelium, but leaves the back endothelial layer in place.
    • The depth of cornea damage determines the right ALK procedure for the patient. SALK (Superficial anterior lamellar keratoplasty) replaces only the front layers of the patient's cornea, leaving the healthy endothelium intact. A DALK (Deep Anterior Lamellar Keratoplasty) transplant procedure is used when cornea damage extends deeper into the stroma.
    • In DALK (Deep Anterior Lamellar Keratoplasty), a small incision is made in the side of the eyeball to allow the removal of the cornea's middle and front layers without damaging the back layers. Healthy tissue from a donor is then grafted to replace the removed portion.

After the procedure

Once the corneal transplantation is completed, the patient can expect to:

  • Receive medications: Eye Drops and, sometimes, oral medications are given to the patient immediately after a corneal transplant. These medications will help control infection, pain, and swelling.
  • Wear an eye patch: The patient is advised to wear an eye-patch; it will protect the eye as it heals after the surgery.
  • Protect the eye from injury: Plan to take it easy after the cornea transplant, and slowly resume your normal activities such as exercise. For the rest of their life, the patients need to take extra precautions to avoid harming the eye.
  • Return for frequent follow-up exams: The patient is advised to visit the doctor frequently for eye exams so that the doctor can find any complications in the first year after surgery.

Test and Diagnosis for Corneal Transplant

  • A thorough eye exam of the patient is done. The eye doctor thoroughly looks for conditions that may cause complications after surgery.
  • The doctor might order lab tests, such as blood work, X-rays, or an EKG.

However, the cost of the procedure may be affected by the following factors:

  • The hospital patient is opting for.
  • Type of Room: Standard single, deluxe, or super deluxe room for the number of nights specified (including meals, nursing fee, room rate, and room service.)
  • Operating room, ICU
  • Fee for the team of doctors (Anesthetist, Surgeons, Physiotherapist, Dietician)
  • Medicines
  • Physiotherapy session
  • Depend on the treatment options
  • Standard test and diagnostic procedures
  • Procedure used:
    • Descemet stripping endothelial keratoplasty (DSEK)
    • Descemet membrane endothelial keratoplasty (DMEK)
    • Anterior lamellar keratoplasty (ALK)

Surgeons may discuss the need for corneal transplants after other viable options to remedy corneal trauma or disease have been discussed. No special preparation for corneal transplant is needed. Some ophthalmologists may request that the patient have a complete physical examination before surgery. Any active eye infection or eye inflammation usually needs to be brought under control before surgery. The patient may also be asked to skip breakfast on the day of surgery.

Corneal transplant is often performed on an outpatient basis, although some patients need brief hospitalization after surgery. The patient will wear an eye patch at least overnight. An eye shield or glasses must be worn to protect the eye until the surgical wound has healed. Eye drops will be prescribed for the patient to use for several weeks after surgery. Some patients require medication for at least a year. These drops include antibiotics to prevent infection as well as corticosteroids to reduce inflammation and prevent graft rejection.

For the first few days after surgery, the eye may feel scratchy and irritated. Vision will be somewhat blurry for as long as several months.

Sutures are often left in place for six months, and occasionally for as long as two years. Some surgeons may prescribe rigid contact lenses to reduce corneal astigmatism that follows corneal transplant.

Corneal transplants are highly successful, with over 90% of the operations achieving restoration of sight. However, there is always some risk associated with any surgery. Complications that can occur include infection, glaucoma, retinal detachment, cataract formation, and rejection.

Graft rejection occurs in 5–30% of patients, a complication possible with any procedure involving tissue transplantation from another person (allograft). Allograft rejection results from a reaction of the patient's immune system to the donor tissue. Cell surface proteins called histocompatibility antigens trigger this reaction. These antigens are often associated with vascular tissue (blood vessels) within the graft tissue. Because the cornea normally contains no blood vessels, it experiences a very low rate of rejection. Generally, blood typing and tissue typing are not needed in corneal transplants, and no close match between donor and recipient is required. However, the Collaborative Corneal Transplantation Study found that patients at high risk for rejection could benefit from receiving corneas from a donor with a matching blood type.

Symptoms of rejection include persistent discomfort, sensitivity to light, redness, or a change in vision. If a rejection reaction does occur, it can usually be blocked by steroid treatment. Rejection reactions may become noticeable within weeks after surgery, but may not occur until 10 or even 20 years after the transplant. When full rejection does occur, the surgery will usually need to be repeated.

Although the cornea is not normally vascular, some corneal diseases cause vascularization (the growth of blood vessels) into the cornea. In patients with these conditions, careful testing of both donor and recipient is performed just as in transplantation of other organs and tissues such as hearts, kidneys, and bone marrow. In such patients, repeated surgery is sometimes necessary in order to achieve a successful transplant.

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