NewYork-Presbyterian ophthalmologists provide advanced, comprehensive, and effective surgical treatment for an extensive array of visual problems. Along with our cutting-edge cornea cataract surgery, NewYork-Presbyterian specializes in cornea transplants. Our ophthalmological surgeons use the most advanced technologies to perform surgical eye procedures.
What is a Cornea Transplant?
What is a Cornea Transplant?A cornea transplant, also known as keratoplasty or corneal transplantation, is a surgery that replaces part or all your cornea. Your cornea is the clear front layer of your eye that helps you to see clearly. During a cornea transplant, the damaged layers of your cornea are replaced with healthy donor tissue.
You may need a cornea transplant if you have any damage to your cornea, either from an illness or injury, that impairs your ability to see. 46,000 people every year have cornea transplants in the United States, making it the most common type of transplant surgery.
What Conditions Does a Cornea Transplant Treat?
What Conditions Does a Cornea Transplant Treat?A cornea transplant may be recommended for anyone with damage to their cornea and blurred vision, eye pain and discomfort, or vision loss. Some of the conditions treated by a cornea transplant are:
- Fuchs’ dystrophy. An inherited condition that causes the cornea's inner layer of cells to malfunction. This makes the cornea swell and thicken, causing blurred vision
- Keratoconus. A condition that causes the cornea to be thin, becoming cone-shaped and causing visual distortions
- Infections. Some infections can lead to corneal ulcers or corneal scarring, causing permanent cornea damage
- Traumatic injuries. Any injury that has penetrated or scarred the cornea
- Damage from previous eye surgeries
- Bullous keratopathy. Blister-like swelling that can cause permanent corneal damage along with eye discomfort, pain, and blurred vision
- Keratitis. Inflammation of the cornea caused by a virus, bacteria, fungi, or parasite
Types of Cornea Transplants
Types of Cornea TransplantsDepending on the extent of damage to your cornea and vision, your eye doctor may recommend different types of cornea transplants. The surgical options include:
- Penetrating keratoplasty. Also called full-thickness cornea transplantation, this procedure removes all layers of your cornea. The surgeon sews the healthy donor cornea onto your eye with extremely thin stitches.
- Endothelial keratoplasty. This is mainly used to treat Fuchs' dystrophy and other medical conditions. This surgery replaces the innermost layer of the cornea, the endothelium, with new tissue. Very few or no stitches are needed during this procedure.
- Anterior lamellar keratoplasty. During this procedure, air is injected into the eye to separate the back layer of the cornea. Only the middle and outer layers are removed and replaced.
- Keratoprosthesis. A surgical procedure where the diseased cornea is replaced with an artificial (man-made) cornea. This procedure is typically only recommended after conventional cornea transplants have failed.
How is a Cornea Transplant Performed?
How is a Cornea Transplant Performed?Different surgeries focus on replacing different layers of the cornea, but all cornea transplants typically take around 1 to 2 hours. Most cornea transplants are outpatient procedures, meaning you do not need to stay at the hospital overnight.
The method a doctor chooses depends on the cause of the damage to the cornea, the cornea’s condition, and the patient, but the basic steps involved in a cornea transplant are:
- Using antibiotic drops in your eye before the surgery to help prevent infection
- Receiving a local anesthetic from the doctor at the hospital. This means you'll be awake, but the area being operated on will be numb. You will be sedated so you don’t have pain or anxiety.
- The doctor will then remove and replace the damaged corneal tissue or the entire cornea (depending on the layer damaged, condition, and patient)
- If the surgery involves the outer cornea, the new outer cornea is held in place with stitches. An endothelial transplant requires one to three sutures and is held in place by an air bubble
Risk Factors
Risk FactorsCornea transplants are fairly common and considered a safe procedure, but there are a few risks to be aware of. Some of the risks associated with a cornea transplant are:
- Eye inflammation
- Retinal detachment (the back lining of the eye pulls away from the eye)
- Eye infection
- Bleeding in the eye
- Higher pressure in the eye (glaucoma)
- Cataracts
- Swelling of the cornea
- Fluid leakage from your cornea
- Visual acuity problems (issues with the sharpness of your vision)
- Corneal transplant rejection – Often reversible
Preparing For a Cornea Transplant
Preparing For a Cornea TransplantYour doctor will conduct an eye exam, and along with the anesthesia team, review your condition and medical history before choosing the best treatment plan for you. Some ways you can prepare for your cornea transplant surgery are:
- Telling your doctor about all your medical conditions and any prescription medications or over-the-counter medicines you take
- Not eating or drinking after midnight the night before surgery
- Wearing loose, easy to remove clothing on the day of the procedure
- Not wearing makeup, creams, lotions, or facial jewelry the day of the surgery
- Arranging for someone to drive you home after the procedure
What to Expect After a Cornea Transplant
What to Expect After a Cornea TransplantFollowing your doctor's instructions carefully is important to protect your eye from injury after your cornea surgery. Your cornea doesn't get any blood, so it heals more slowly than other body areas. Typically, your eye will be red, irritated, and sensitive to light for the first few days after surgery.
After surgery:
- Your eye will be covered with an eye patch which is usually removed the next day. An eye shield must be worn when you shower and sleep.
- Your doctor will recommend that you wear glasses or other protective eyewear for a period of time to help protect your eye.
- After surgery, you should avoid rubbing or pressing on your eyes.
- Your doctor will suggest you take an over-the-counter pain reliever such as Tylenol to help with discomfort and irritation.
- Your doctor will prescribe eye drops to bring down swelling and protect against infection.
- You will have to return to the hospital within 24-48 hours of surgery so the doctor can monitor your healing.
- You will have your eye checked several times in the months following the surgery.
- For transplant procedures that use a gas bubble inside your eye, usually the endothelial keratoplasty, the surgeon may ask you to lie flat during the day and sleep flat on your back at night for a few days.
- You will have to avoid activities that could result in a direct hit to your eye for a while, such as contact sports.
- If your transplant procedure required stitches, your doctor will take them out weeks to months later. Sometimes sutures are not removed and allowed to dissolve by themselves.
FAQs
Leaders in Endothelial Keratoplasty
The Department of Ophthalmology at NewYork-Presbyterian and the Edward S. Harkness Eye Institute are leading international centers for the diagnosis and treatment of diseases of the eye. The very first corneal transplant in the United States was performed at the Edward S. Harkness Eye Institute, by surgeon Ramon Castroviejo, in 1933.
Along with our team of specialists, we offer patients the most advanced, comprehensive, and effective eye care. State-of-the-art high-tech equipment enables our highly skilled physicians to perform advanced procedures in our facilities right in New York, close to home.
Call to make an appointment with one of our ophthalmology specialists at our offices in Manhattan and Westchester to see which treatment plan is right for you.