What to Expect When You Have a Corneal Transplant – Eye Love Cares
If your doctor has recently recommended a corneal transplant for you or your loved one, you probably have a lot of questions and concerns.
Maybe you don’t understand why you need this surgery or what will happen to your sight if the surgery is not completed or performed improperly. Perhaps you have questions about what happens during the surgery itself and how to pick a qualified doctor to perform the operation. Maybe you want to know about the recovery process after the surgery is done. Read on to have some of your questions answered regarding your upcoming corneal transplant surgery.
Why is the Cornea Important?
A cornea is the transparent surface of your eye. The cornea should be as smooth and clear as glass. The cornea has several functions.
First, its strong and durable surface protects the rest of the eye from contaminants such as dust, germs, and other foreign materials.
It also acts as the outermost lens of the eye. In fact, the cornea is so vital that it contributes between 65 to 75 percent of the eye’s focusing power.
When light hits the cornea, it bends it onto the lens. The lens further refocuses that light onto the retina. The retina converts the light into impulses that are sent through the optic nerve to the brain. While all the parts of the eye work together to allow you to see, the cornea completes the first part of that process.
Finally, the cornea works as a filter. It screens out damaging UV wavelengths in sunlight and protects the lens and retina from injury.
After you understand all the critical functions of a cornea, it is clear why a damaged or diseased cornea should be replaced.
Related: Corneal Crosslinking
Parts of the Cornea
The cornea has three main layers, but five layers total:
- The epithelium is the outermost layer. This layer acts as a protective barrier, and it also absorbs oxygen and nutrients from your body’s tears.
- The stroma is the middle layer of the cornea. It is the thickest layer and made mostly of water and proteins. The stroma has an elastic, solid form.
- The endothelium is a single layer of cells at the back of the stroma. While the stroma absorbs excess liquid in your eyes, the endothelium acts as a pump and pulls the excess fluid out of the eye. Without the endothelium, your cornea would get hazy, and you wouldn’t be able to see well.
- Bowman’s layer lies between the epithelium and stroma, and Descemet’s membrane lies between the stroma and the endothelium.
Who Needs a Corneal Transplant?
Several conditions might result in needing a corneal transplant. First, a corneal transplant can help restore vision to a person who has a damaged cornea. A transplant can also help eliminate pain and other symptoms that come with some eye diseases.
One of the diseases that might result in a corneal transplant is keratoconus. Keratoconus is when the cornea thins and begins to bulge into the shape of a cone. Since the cone is misshapen, it may cause one’s vision to be distorted. The disease may also cause swelling, scars on the cornea, and vision loss. It can severely affect your night vision. Keratoconus is hereditary, but it can also be caused by overexposure to UV rays or chronic eye irritation and rubbing.
Other eye diseases contribute to keratoconus. Some of them include retinitis pigmentosa, retinopathy of prematurity, vernal keratoconjunctivitis, osteogenesis imperfect, Addison’s disease, Leber’s congenital amaurosis, and Ehlers-Danlos syndrome. Those with Down Syndrome may also be more likely to develop keratoconus.
Another disease that may lead to a corneal transplant is Fuchs’ dystrophy. Fuchs’ dystrophy shows itself when bumps form on the cells of your cornea. These bumps later cause your cornea to swell and make your vision blurry. Fuchs’ dystrophy is genetic, and women are more likely to get it than men. Although you may have the beginning of the disease while you are in your 30s or 40s, it often takes about 20 years before your vision is affected enough by the disease to necessitate a corneal transplant. One sign of this disease is waking up with blurred vision that gets better as the day progresses. If you have this symptom, you should consult with your doctor immediately.
Another disease of the cornea is lattice dystrophy. This occurs when there are abnormal protein fibers in the stroma or middle layer of the cornea. The overlapping lines of protein look like lattice.
You may need a corneal transplant because of the condition called keratitis. This inflammatory disease is caused after either a viral, bacterial, or fungal attack of the cornea. Injuries and infections can also cause keratitis, and corneal ulcers are a big reason why people undergo corneal replacement.
Other non-eye diseases may damage your cornea. These can include shingles, which is caused by the same virus that causes chickenpox. The virus that causes chickenpox can travel through the nerve fibers and emerge in the cornea. This virus can live in your body for decades not causing any issues, but when it does appear again, the rash may appear on your face. If this is the case, the rash can cause sores on your cornea. Most of the time these sores heal by themselves, but sometimes an antiviral medication needs to be used to promote healing. If the cornea is damaged, a corneal transplant may need to be performed. Shingles usually occurs in adults over 80 years old who have a weakened immune system.
Ocular herpes is another viral infection that can affect the cornea. This is the same virus that causes cold sores. The virus that causes genital herpes can also affect the cornea. This condition creates lesions on the cornea and causes inflammation of your eye that can spread.
Your doctor may also recommend that you have a corneal transplant if your cornea is thinning as the result of a disease. You also may be ready for a corneal transplant if your current one becomes swollen or clouded. Some of these issues with your cornea may be caused by illness or infection, but they could also have been caused by previous eye surgery.
Finally, it may be necessary for you to have a corneal transplant because of a bruise, laceration, or burn on the cornea that caused scarring. This scarring may cause blurred vision, but it also can cause total blindness. While sometimes corneal abrasions heal on their own, deep scarring can result in the loss of corneal tissue.
What Are the Risks Associated with Having a Cornea Transplant?
Most of the time, corneal transplants are safe and can help restore eyesight and eye comfort. Like any other surgery, if you undergo a corneal transplant, there is a risk of infection. You also have an increased risk of developing a cataract after corneal transplant surgery. You may find that the pressure increases within your eyeball. High pressure in the eyes over time can lead to glaucoma.
Other risks of a corneal transplant surgery include swelling of the cornea and problems with the stitches used during the operation.
Finally, your body may reject the donor’s cornea that is used during the surgery. This is a risk associated with any transplant surgery on any part of the body.
Related: Can Your Eyes Change Color?
Signs of Cornea Rejection
For those undergoing corneal transplant surgery, one of the biggest concerns is that your body will reject the donated cornea. Symptoms that your body may be rejecting the cornea include a loss of vision, eye pain, redness, and sensitivity to lights. 10 percent of patients who receive a corneal transplant suffer from these rejection symptoms.
Although not just signs of corneal rejection, if you have any of these other signs, you need to seek medical attention immediately. Go to the ER if you have shortness of breath, chest pain, a fever, chills, nausea, or vomiting.
Most of the time, you will not suffer from side effects after your surgery. Corneal transplants are relatively common in the United States. According to the National Eye Institute, there are about 40,000 corneal transplants performed per year.
What You Need to Do Before Cornea Transplant Surgery
Of course, one of the first steps you will undertake before having a corneal transplant is to have a complete and thorough eye exam by a qualified physician. Your doctor will look at your overall health to determine if you have any other conditions that may cause you to have complications as a result of the surgery.
Make sure you share with your doctor a list of all the medications, vitamins, and supplements you are taking. You may need to stop taking some of them, such as aspirin, before or after your surgery. You also may have to use antibiotic eye drops in your eyes the day before your transplant to help prevent an infection from developing.
Your doctor will give you specific instructions to follow before your procedure. He or she may require that you do not eat or drink after midnight on the night before the surgery. You may also be asked to wear loose, comfortable clothing on the day of your procedure. Make sure you arrive with your face free of makeup or lotions. Leave your jewelry at home.
You will need someone to drive you home after your procedure. Check with your doctor as to when you can begin driving again. If you have good vision in your non-transplant eye, you can usually drive 24 hours after your surgery.
During the exam, your doctor will measure your eye to determine what size donor cornea you will need. Corneas used in transplant surgeries come from deceased donors. Usually, there are not long waits to receive a cornea from a donor. People who die from unknown causes or who have prior eye conditions may be exempt from donating their corneas. Corneas are also not harvested from cadavers that have a disease of the nervous system.
Related: Why Is My Eye Twitching?
What Happens During Corneal Transplant Surgery
You will be awake during your operation, but you will not feel any pain. You also will probably not remember anything from the surgery as you will be given a sedative to help you relax.
The doctor will complete the entire surgery while looking through a microscope. Depending on the type of surgery, corneal transplants usually take around two hours. You’ll spend an additional one or two hours in the recovery room after your surgery is complete.
Although techniques continue to improve and change, during a primary corneal transplant surgery, your surgeon will cut through the existing cornea with an instrument that acts like a cookie cutter. The small, button-sized disk of diseased or damaged cornea tissue is removed during this process.
The donor cornea is cut to fit and is placed in the opening of your cornea. The new cornea is stitched into place by your surgeon. These stitches may be removed at a later visit.
There are other types of corneal transplant surgeries. During an endothelial keratoplasty, diseased tissues from the back corneal layers are removed and replaced with donor tissue.
During a Descemet stripping endothelial keratoplasty, the donor tissue replaces one-third of the cornea. During a Descemet membrane endothelial keratoplasty, a much thinner layer of the donor’s tissue is used. This procedure is more challenging to perform.
Your doctor may also tell you that he or she will be performing an anterior lamellar keratoplasty. This procedure removes tissue from the front corneal layers but leaves the back layers of the cornea in place.
Finally, the depth of your cut may vary depending on how deep the disease runs in your cornea.
What Happens After Your Corneal Transplant
Most patients who have a corneal transplant will be able to go home the same day.
After your surgery, you will receive antibiotic eye drops and sometimes oral medications to help you control the swelling and pain caused by the operation. You will also be given medicine to help fight infection.
You may also need to embrace the pirate look for a time after your surgery and wear an eye patch as your eye heals. Sometimes you can stop wearing the eye patch after one day, but you may have to keep it on for up to four days. At least the top layer of your cornea needs to heal before taking off your eye patch.
During this healing process, you will be extra sensitive to light. Your eye may also be red and sore for a few days. Some people experience zero discomfort after surgery.
Interestingly enough, your cornea doesn’t receive any blood in the body’s natural circulation process. This means that the cornea does not heal quickly.
You shouldn’t plan to jump right back into your normal daily activities after having a corneal transplant. Your eyes will need to recover, and you may need to be careful for the rest of your life with your eye health.
Just like other surgeries, you will need to return to your surgeon or your eye doctor for follow-up visits. Your doctor will want to see you the day after your surgery, several times during the first couple weeks, and then a few more times during the first year.
After your eyes have healed, you will need to see your eye doctor at least annually to make sure your body is not rejecting your new cornea. Sometimes cornea rejection can be managed by taking medications.
Results of Having a Corneal Transplant
Hopefully, your vision will be at least partially restored after having a corneal transplant. This may take time, from several weeks to several months. In fact, your vision may be worse after the surgery than before the surgery. Do not become disheartened.
If your vision does not seem to improve, there are things that your doctor can do to help correct it.
Sometimes the cornea becomes uneven after the surgery. This causes astigmatism in the eye and can make your vision blurry. This may be fixed by adjusting the stitches that are holding the donor cornea in the eye. Adjusting the stitches adjusts the shape of your eye and can improve your vision.
After your eyes have healed, your doctor can fit you with glasses or contacts to help you achieve the best eyesight possible. Check with your doctor to see if you can have laser eye surgery to correct your vision after having a corneal transplant.
Once your corneal transplant is completed, the donated tissue usually lasts the rest of your lifetime.
Prevention of Corneal Disease
While some diseases are hereditary, there are some steps you can take to lower the chance of corneal infections.
First, if you wear contact lenses, follow the directions for use. Don’t sleep in your contacts, even if you are supposed to be able to do so according to the instructions. Sleeping in contacts raises the risk of infections.
How to Pick a Doctor to Perform Your Surgery
Consult your general practitioner to seek a recommendation for an eye doctor or surgeon. Your doctor should have a good feel for which doctors are best in your area.
You might also want to consult with friends and family to see which doctors they have visited. Keep in mind that not every individual will be happy with every doctor. This doesn’t mean that there is anything wrong with the doctor. If several people have the same complaints about the same doctor, you might be concerned enough to choose another person to provide you with care.
Of course, you can check the websites of professional organizations to see which doctors are registered in your area. Consult the American Academy of Ophthalmology and the American Optometric Association.
Make an appointment with the doctor, and then analyze your visit after you have left:
Did you have to wait a long time for no apparent reason? Doctors sometimes have emergencies, and grace should be given to him or her if that is the case.
Did you feel rushed by your doctor? Did he or she listen to your explanation of your symptoms? Did he or she answer your questions?
Did you feel comfortable with the doctor?
If you feel uncomfortable when thinking about the visit, you may want to consult with another physician before making the decision. It’s always good to go with your gut instinct.
While many patients may say they are going to visit the eye doctor, there is a difference among ophthalmologists, optometrists, and opticians.
Ophthalmologists are medical doctors who specialize in eye health and vision care. They can perform surgeries and treat eye disease. They can also fit you with eyeglasses and contact lenses to correct your vision problems. They have graduated from college plus received at least eight additional years of medical training to become an ophthalmologist.
Optometrists are eye care professionals who have completed a four year doctorate degree. They receive a doctorate of optometry, which means they went to four years of optometry school after four or more years of college. Optometrists are licensed professionals, and their primary function is prescribing corrective lenses and treating common eye diseases. They can detect specific eye abnormalities and prescribe medications for certain eye diseases. They may send patients with complicated issues to ophthalmologists.
Opticians are also trained professionals, but they do not have to go through as extensive schooling as ophthalmologists and optometrists. They fit eyeglasses and contact lenses on patients, but they do not test a patient’s vision or write prescriptions. They do not treat eye diseases.
When Should You Visit an Eye Doctor?
At a minimum, you should visit an eye doctor once a year. If you have been diagnosed with AIDS or HIV, diabetes, high blood pressure, or thyroid disease, you should also make an appointment with your ophthalmologist as well to make sure that the conditions affecting other parts of your body are not harming the health of your eyes.
Getting fitted for glasses or contacts is not the only reason to visit an optometrist or ophthalmologist. Also, visit them if it seems you have a dark curtain that blocks your vision or if you are experiencing double vision or distorted vision.
Visit the doctor if your eyelid seems abnormal or if you see colored circles around lights. Make an appointment if you see floaters, flashes of light, or if your eyes are unusually red. Always go to the doctor if you can’t see or if you have a pain in your eye.
There are other choices you can make that will help keep your eyes healthy. One of those choices is to stop smoking. Smokers are more likely than non-smokers to develop cataracts in their eyes and to develop macular degeneration. Smoking also causes the middle layer of the eyes to be inflamed. This inflammation leads to glaucoma and retinal detachments.
Also, remember to wear sunglasses. While the cornea does protect the rest of your eye from harmful UV rays, it needs help.
Besides wearing sunglasses, also keep a brimmed hat on your head when you are outdoors. This blocks the rays from entering your eyes from the sides of the sunglasses. Purchase sunglasses that block 100 percent of UVA and UVB rays. These glasses may be labeled UV 400. Remember to purchase polarized lenses to cut down on the amount of glare on your eyes.
Some corneal transplants are needed because the cornea experienced trauma, such as a bruise, cut, or burn. Reduce the chance of receiving a wound to the cornea by wearing safety glasses. Wear safety glasses if you work in construction, manufacturing, carpentry, plumbing, welding, or auto repair. Also, wear glasses if you work with chemicals or body fluids. Use protective glasses when shooting a gun and mowing your lawn.
Some issues with eyes are caused by inflammation, and this inflammation is sometimes caused by dryness. Learn methods to combat the dryness of your eyes, such as limiting the amount of time you stare at a screen. When we stare at a computer or television screen, we tend to blink less. Since blinking refreshes the eyes, it is no wonder that our eyes seem so tired after a long session on the computer. Remind yourself to take a break from staring at your computer screen. Every 20 minutes, you should look 20 feet away for 20 seconds.
Remember to really give your eyes a rest. Looking from your computer’s screen to your phone screen does not cut it. Try to remember to blink more as you work.
Eat plenty of leafy, green vegetables and colorful fruits. Carrots, sweet potatoes, spinach, kale, and cantaloupes are especially good for eye health. Also eat foods rich in Vitamin E such as seeds, salmon, and avocados.
The B vitamins are also essential for your eye health because they help fight inflammation. The B complex vitamins can be found in tuna, eggs, and dairy products.
Don’t be discouraged if you eat the right foods and avoid smoke but still require a corneal transplant at some time in your life. As we learned, some of the diseases that may require such a procedure are hereditary. Instead of being irritated at yourself on not caring for your eyes, you can instead be annoyed with your parents.