Background Information:

What are the other Names for the Procedure?

• Corneal Graft
• Corneal Transplant
• Keratoplasty

What is Cornea Transplant surgical procedure?

A Cornea Transplant involves surgically removing all or part of a diseased or injured cornea of the patient and replacing it with a healthy corneal tissue from a donor (normally from a deceased person).

What part of the Body does the Procedure involve?

A Cornea Transplant procedure involves the corneal tissues of a person’s eyes.

Why is the Cornea Transplant surgical procedure Performed?

The reasons for performing a Cornea Transplant are:

• To prevent blindness
• To restore vision
• To reduce pain associated with a diseased cornea
• Corneal ulcers
• Swelling of cornea
• Clouding of cornea
• Complications caused by an eye injury (recent or past)

What are some Alternative Choices for the Procedure?

Phototherapeutic Keratectomy (PTK) is considered an alternative for Corneal Transplant. In this procedure a laser is used to remove the diseased corneal tissue and allowed to heal over a period of time, thereby restoring vision. However, this technique is most beneficial if damage to the corneas, is not too deep into the tissue.

What are the Recent Advances in the Procedure?

Depending on where the problem lies within the cornea, the surgeon may perform grafting of either the anterior (front) or endothelial (back) portion of the cornea. This is known as DLEK (Deep Lamellar Endothelial Keratoplasty) and DSEK (Descemet’s Stripping Endothelial Keratoplasty). Such procedures do not normally require sutures. These are some of the recent advances in Cornea Grafting procedures.

What is the Cost of performing the Cornea Transplant surgical procedure?

The cost of Corneal Transplant procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Corneal Transplant and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required

What are some Helpful Resources?

http://www.kellogg.umich.edu/patientcare/downloads/Understand-Corneal-Transplant-Surgery.pdf

http://www.mayoclinic.com/health/cornea-transplant/MY00491/DSECTION=how-you-prepare

http://www.surgeryencyclopedia.com/Ce-Fi/Corneal-Transplantation.html#b

Prior to Cornea Transplant surgical procedure:

How is the Cornea Transplant surgical procedure Performed?

• During the Cornea Transplant, a trephine (a tiny cutter knife) is used to extract or remove the patient’s damaged cornea
• Once the cornea is removed, the donor cornea is placed on the site for grafting and fixed in position with the help of tiny sutures
• The sutures are removed after a period of 3-4 weeks, on ensuring that the healing is complete

Where is the Procedure Performed?

A Cornea Transplant is performed in a hospital wherein the patient gets admitted, undergoes the procedure and is discharged, as per the instruction of the physician.

Who Performs the Procedure?

The surgery is performed by an ophthalmologist.

How long will the Procedure take?

The procedure will take about 1-2 hours to perform.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

Prior to a Cornea Transplant procedure, the following are required to be ensured:

• Registration for a donor cornea
• Thorough eye examination for any problem that could result in a complication either pre- or post- surgery
• Any eye related diseases or problems have to be treated beforehand
• The size of the patient’s cornea (has to be determined) 

Other preparations required prior to the procedure include:

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Local anesthesia may be used; if so do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

A physician will request your consent for the Cornea Transplant using an Informed Consent Form.

What is the Consent Process before the Procedure?

A physician will request your consent for the Cornea Transplant using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Cornea Transplant surgical procedure?

Before a Cornea Transplant the patient must have certain tests done, as advised by the physician:

• Complete eye examination
• Routine blood and urine analysis

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Cornea Transplant?
• Why is this procedure necessary? How will this procedure help?
• What does the procedure involve?
• How soon should I get it done? Is there an emergency?
• Will my vision be restored immediately and completely?
• Are there any chances of graft rejection?
• What happens if the surgery is not a success?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
• Is there any medication that needs to be taken for life, after the procedure?
• What are the costs involved?

During the Cornea Transplant surgical procedure:

What kind of Anesthesia is given, during the Procedure?

During the procedure the patient is administered either a local or a general anesthesia.

How much Blood will you lose, during the Procedure?

The corneas of the eye do not contain any blood vessels, hence there is little or no blood loss involved.

What are the possible Risks and Complications during the Cornea Transplant surgical procedure?

The possible risks or complications that may arise during the surgery are:

• Surgical wound infection
• Accidental damage to surrounding tissue

What Post-Operative Care is needed at the Healthcare Facility after the Cornea Transplant surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise.

After the Cornea Transplant surgical procedure:

What are the possible Risks and Complications after the Cornea Transplant surgical procedure?

The possible risks and complications that may arise after a Cornea Transplant are:

• Infection in the surgical wound
• Rejection of the graft (may occur in about 5% of the patients)
• Redness, sensitivity to light, pain, and changes in vision are symptoms of graft rejection
• Secondary glaucoma
• Retinal detachment
• Cataract formation
• Loosening or breaking of sutures
• Astigmatism; when the shape of cornea is different from the natural round shape

What is the Prognosis after the Surgery?

• Corneal grafting surgeries have a high success rate. Chances of graft rejection remain low or are rare
• Some patients gain complete vision within a couple of weeks of the surgery. However at times, it may even take up to a year to gain optimum vision

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain around the surgical wound
• Swelling and redness of the eyes
• Bleeding or fluid drainage
• Dizziness
• Headache
• Fever
• Nausea, vomiting, or constipation
• Changes in vision

What Post-Operative Care is needed at Home after the Cornea Transplant surgical procedure?

At home, the following post-operative care is recommended, after a Corneal Transplant procedure:

• Use eye drops (under advice by the physician)
• Use eye shields till complete recovery is confirmed
• Complete the course of medication if any prescribed
• Do not take any non-prescribed pain killers
• Resume daily activities as early as possible (per physician’s advice)
• Avoid vigorous exercise
• Resume driving, only when your physician confirms complete healing

How long does it normally take to fully recover, from the Procedure?

It takes about 3-4 weeks to completely recover from a Corneal Transplant procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Cornea Transplant surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital
• An ophthalmologist
• An anesthesiologist (if anesthesia was administered)
• A pathologist (if the tissue was sent for analysis)

The patient is advised to inquire and confirm the type of billing, before Corneal Transplant procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA