Corneal Transplantation FAQ

 

What is Corneal Transplant Surgery?

The cornea is the clear, round dome on the front of the eye. When it is diseased and becomes cloudy, corneal transplantation is performed to remove the diseased cornea and to replace it with a healthy and clear cornea.

Is There Such A Thing As Whole Eye Transplantation?

No. Some of the eye structures such as the retina and optic nerve are delicate and cannot be restored once damaged. If the eye is cut out completely, the connection between the eye and brain is permanently lost and results in total blindness.

How Do You Get New Corneal Tissue for Transplantation?

Each state has an Eye Bank which is accredited and certified. The Georgia Eye Bank is located in Atlanta and services the entire state. Organ donors consent to organ transplantation prior to passing.

What Kinds of Corneal Transplant Surgeries Are There?

There are 3 general types:

  • Penetrating Keratoplasty (PKP): the entire cornea is removed, similar to cutting cookie dough with a cookie cutter all the way through.
  • Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK): only the back layers of the cornea are removed for conditions such as Fuchs endothelial dystrophy (inherited) or pseudophakic bullous keratopathy (complication after cataract surgery).
  • Deep Anterior Lamellar Keratoplasty (DALK): only the front layers of the cornea are removed for conditions such as corneal scars (from infections or trauma), keratoconus (degenerative) , or pellucid marginal degeneration (degenerative).

What are the Pros and Cons of Each?

  • PKP has been performed for decades and is the first form of corneal transplantation. Did you know the cornea was the very first successful organ transplanted performed in humans? PKP was the primary form of transplantation but it performed less commonly because DSAEK and DALK only require removal of the diseased cornea so they are preferred over PKP whenever possible. PKP has higher risk of complication such as bleeding, stitch related infections, irregular astigmatism, and tissue rejection also known as graft rejection.
  • DSAEK does not require any stitches. The tissue sticks to the eye by the use of an air bubble. This results in faster visual recovery, less surgical risk, faster surgical time, less risk for rejection, and less risk for irregular astigmatism which means better vision compared to PKP.
  • DALK requires the use of stitches to place the tissue but the back surface tissue is preserved. The back tissue consists of descemet's membrane and endothelium. The endothelium is responsible for tissue rejection. But since the endothelium is maintained, there is no risk for endothelial rejection with DALK. DALK offers less risk for rejection, less risk for surgical complication, faster stitch removal, and faster visual recovery compared with PKP.
  • Sometimes patients have disease in all layers of the cornea, when this happens DSAEK and DALK are not good options and PKP is the best choice.

Is There Such a Thing as a Bionic Eye?

No, but there is such a thing as an artificial cornea, which is the closest thing. The artificial cornea is used for patients who have had multiple corneal transplants and have very sick corneas. These patients can have an artificial cornea. The Boston Keratoprosthesis Type 1 is an example of an artifical corneal prosthesis.

What are Signs of Tissue/Graft Rejection?

Vision loss, red eye, pain, or sensitivity to light. You need to see your surgeon as soon as possibly if this happens.

Can the Cornea be Saved After Rejection?

Yes. If your corneal specialist catches the rejection early enough, aggressive treatment can save the cornea and preserve vision.

What Happens If It's Too Late?

If the vision cannot be restored after tissue/graft rejection, then a new corneal transplant surgery may need to be performed to restore the vision. This is why it's so important for you to seek help from your surgeon as soon as possible if you suspect that you are having a rejection episode.

Who Does Corneal Transplantation?

An opthalmologist with additional subspecialty training in corneal transplantation performs these surgeries. At Professional Eye Associates, we have the area's only fellowship-trained corneal surgeon, Dr. Brian Kim, M.D. After corneal transplantation surgery, regular visits to the office are required to ensure that the new cornea is healthy and doing well. If your specialist is far away from home, this will result in many long travel days with significant expense to you. But thankfully you don't have to go far to see a corneal specialist because we have one right here. Dr. Kim has restored the sight of many corneal transplant patients through surgery. It is a life-changing experience. Call to make an appointment. We would be honored to help.