Cornea / Corneal Transplant

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Definitions:
The cornea is the clear front window of the eye. Light is focused by the cornea and lens so that we can see clearly. A corneal transplant replaces a cloudy cornea with a donor cornea. If the cornea is injured, it may become swollen or scarred, and its smoothness and clarity may be lost. Scars, swelling, or an irregular shape can cause the cornea to scatter or distort light, resulting in glare or blurred vision.

Selective Cornea Transplantation:
The cornea is made up of several different layers. A problem to any of these layers can cause the cornea to become cloudy, swollen, or misshapen, leading to blurry vision. When surgery is indicated to help improve vision, a full thickness cornea transplant has traditionally been offered.

it is now possible to transplant only the diseased layers of the cornea. Examples of this are Descemet’s stripping endothelial keratoplasty (DSEK) or Descemet’s membrane endothelial keratoplasty (DMEK) for conditions like Fuchs’ Dystrophy, and deep anterior lamellar keratoplasty for conditions like keratoconus. In fact, the first DMEK performed in Connecticut was done here at OptiCare. Benefits of selective cornea transplantation include a lower chance of intraoperative bleeding, patients keeping their normal corneal tissue layers, and faster recovery.

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INTACS:

For patients with thin, irregular corneas from keratoconus or ectasia after refractive surgery, highly skilled optometrists can help improve vision with glasses, contact lenses, and specialty contact lenses. If vision cannot be corrected satisfactorily, or if the condition is progressive, surgery might help allow the vision to be corrected and progression of the irregularity to stop. Cornea transplantation is one such option, but can be deferred by a procedure called INTACS.

INTACS involves implanting a pair of clear ring segments into the cornea in order to strengthen it and make it more regular. Two small channels are made within the cornea at approximately 75% depth and the ring segments are slid into place. The center of the cornea is not disturbed, the partial thickness depth of the rings means that the eye is not penetrated, and the effects of the ring segments can be reversed or adjusted by removing them. They can improve the best attainable vision with glasses or contact lenses, and slow the progression of corneal thinning.

What You Can Expect:

This surgery is usually performed on an outpatient basis. One of our corneal specialists: Lorenzo Cervantes, M.D., Olga Konykhov, M.D., and Jessica Schonfeld, M.D. will carefully remove the damaged or diseased cornea. Then the clear donor cornea is sewn into place.

Who Is a Good Candidate:

A corneal transplant may help if the cornea is significantly scarred or swollen and other treatments are no longer effective or unavailable. A corneal transplant is needed if vision cannot be corrected satisfactorily with eyeglasses or contact lenses or if painful swelling cannot be relieved by medications or special contact lenses.

What conditions may cause the need for a corneal transplant?
* keratoconus, a steep curving of the cornea
* hereditary corneal failure, such as Fuchs’ dystrophy
* scarring after infections, especially after herpes simplex infections
* rejection after a first corneal transplant
* scarring after traumatic injury

Procedures:
Once you and your doctor decide you need a corneal transplant, your name is put on a list at the local eye bank. Usually the wait for a donor cornea is not very long. because there is no need to get matched to a donor.

Before a cornea is released for transplant, the eye bank tests the human donor for potential communicable diseases, like the viruses that cause hepatitis and AIDS. The cornea is carefully checked for clarity.

Your doctor may request that you have a physical examination and other special tests. If you usually take medications, ask your doctor if you should continue using them.

On the day of surgery, you may be asked to skip breakfast, depending on the time of your surgery. Once you arrive for surgery, you will be given eyedrops and perhaps a mild sedative to help you relax. You will meet with the anesthesiologist who will discuss the best anesthesia for your surgery. You will not see the surgery while it is happening.

Your surgeon will view your eye through a surgical microscope. The diseased or injured cornea is carefully removed from the eye. Any necessary additional work within the eye, such as removal of a cataract, is then completed. Then the clear donor cornea is inserted or sewn into place. When the operation is over, your doctor will usually place a shield over your eye.

You may go home after a short stay in the recovery area. You should plan to have someone drive you home. An examination at the doctor’s office will be scheduled for the following day.

Postoperative care:
use eyedrops as prescribed
* be careful not to rub or press on your eye
* use over-the-counter pain medicine, if necessary
* continue normal daily activities but avoid strenuous exercise or activities
* wear eyeglasses or an eye shield for protection, as advised by your doctor
* ask your doctor when you can start driving again
* call your doctor if you have any questions about your home-care instructions

Your surgeon will decide when to remove the stitches, if necessary, depending upon the health of your eye and rate of healing.

Corneal transplant surgery would not be possible without the thousands of generous donors and their families who donate corneal tissue so that others may see.

Risks:

Corneal transplants are rejected 5% to 30% of the time. The rejected cornea clouds and vision deteriorates.

Most rejections, if treated promptly, can be stopped with minimal injury. Warning signs of rejection include persistent discomfort, light sensitivity, redness, and changes in vision. Any of these symptoms should be reported to your ophthalmologist immediately.

Other possible complications include infection, bleeding, swelling or detachment of the retina, and glaucoma. All of these complications can be treated.

Corneal transplantation can be repeated, usually with good results, but the overall rejection rates for repeat transplants are higher than for the first transplant. Irregular curvature of the transplanted cornea (astigmatism) may slow the return of vision but can also be treated. Vision may continue to improve up to a year after surgery.

Even if the surgery is successful, other existing eye conditions, such as macular degeneration, glaucoma, or diabetic retinopathy, may limit vision after surgery. Even with such problems, a corneal transplant may still be worthwhile.

A successful corneal transplant requires care and attention on the part of both patient and physician. However, no other surgery has so much to offer when the cause of decreased vision is a loss of corneal transparency.


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