Why would I need a corneal transplant?
The cornea is a window of transparent tissue at the front of the eyeball. It allows light to pass into the eye and provides focus so that images can be seen. Various diseases or injury can make the cornea either cloudy or out of shape. This prevents the normal passage of light and affects vision.
A cloudy cornea can be replaced by a healthy one from a donor to restore vision (see image). If the full thickness of the cornea is affected by disease, then a full thickness transplant is performed. This is known as a penetrating keratoplasty.
Benefits of penetrating keratoplasty
Improved vision
- Approximately 75% of transplant recipients have good enough vision to drive legally but usually need glasses or contact lenses or sometimes further surgery for best results
- It may take up to 24 months until the full improvement in vision is seen.
Risks of penetrating keratoplasty
- Rare but serious complications
- Sight-threatening infection (1 in 1,000)
- Severe haemorrhage causing loss of vision
- Retinal detachment
- Severe inflammation or other rare causes of vision loss.
Corneal transplant rejection
A corneal transplant may be rejected by your immune system. This happens in one in six patients in the first two years after transplantation and can cause graft failure. It can often be reversed if anti-rejection medication is started promptly, but rejection remains a possibility in your lifetime.
Graft failure
When a graft fails, your cornea becomes cloudy again and your vision becomes blurred. See the table below for more detailed information on graft survival.
About the operation
The operation
The operation is performed under general or local anaesthetic and takes about one hour. A central 8mm button of your cornea is removed and a
similar-sized button of the donor cornea is stitched in with tiny stitches (see front cover of leaflet). These cannot be felt or seen. The abnormal cornea, which is removed, is sent to our pathology laboratory for examination under a microscope.
After the operation
You will usually be examined by the surgical team after the surgery and can generally go home the same day. You will be seen again within one week in the outpatient clinic and regularly thereafter (approximately six visits in the first year). We generally recommend that you take two weeks off work but please discuss your individual circumstances with your doctor. You will need to use anti-rejection eye drops for at least six months and indefinitely in some cases. Individual stitches may be removed from three months after the operation, but complete stitch removal is not performed until at least one year after the procedure.
What if my transplant fails?
A failed transplant can be replaced in a procedure known as a regraft. However, the risk of further rejection and failure increases each time for subsequent regrafts.
The percentages of full-thickness corneal grafts that are still functioning well under various conditions five years after the operation are:
| Condition | % |
|---|---|
| Keratoconus | 95 |
| Fuchs’ dystrophy | 80-90 |
| Stromal scar | 80-90 |
| Stromal dystrophies | 80-90 |
| Bullous keratopathy | 50-80 |
| Bacterial infections | 50-80 |
| Herpetic keratitis | 50-80 |
| Fungal infection | 0-50 |
| Third or higher number re-graft | 0-50 |
| Four quadrants of blood vessels | 0-50 |
| Inflammation at time of surgery | 0-50 |
| Severe ocular surface disease | 0-50 |
| Grafts greater than 10mm | 0-50 |
Corneal transplant rejection
Rejection needs urgent treatment as this can lead to failure of the transplant and loss of vision.
Symptoms of rejection are:
- Red eye
- Sensitivity to light
- Visual loss
- Pain
If you experience any of these symptoms you should come immediately to our 24-hour emergency department. If in doubt, call 020 7253 3411 and ask to speak with the doctor on duty in the emergency department.
Consenting for information sharing
To comply with the law and to ensure high quality transplant material, we are required to share your information with the NHS Blood and Transplant Special Health Authority (NHSBT), who supply donor corneas. However, we require your consent to share this information. If you do not give consent for your information to be shared with or held by the NHSBT, this may affect availability of donor tissue for the transplant or create problems with contacting you should any issues be identified later on with the tissue you received.
Review: February 2020