Corneal Transplant Surgery
Corneal transplant surgery is the most commonly performed transplant operation, with approximately 45,000 corneal transplant procedures performed in the United States each year.
A Brief History
In 1933, corneal transplants were performed using two razor blades to make a square graft. Patients were hospitalized for two weeks with sand bags on either side of their head to prevent undesirable movement and possible leakage from the wound site.
Since then, there have been major advances in surgical technique, including the introduction of the operating microscope (1970s), better suture needles and materials, newer instruments, corneal punches, and viscoelastics (which protect the endothelium – the innermost layer of the cornea). Due to improved techniques and instrumentation, corneal transplants are now routinely performed as outpatient surgery, under local anesthesia, and on a wider array of conditions.
Your Cornea
The cornea is the clear, circular, protruding part of your eye. It is often referred to as the “window” of the eye. The cornea must remain transparent in order to have good vision. Disease and/or trauma can reduce this transparency and result in vision loss
The cornea has five layers:
1) Epithelium: the outermost layer of the cornea, which serves as a boundary against infection and foreign materials such as dust and water.
2) Bowman’s layer: a transparent layer made up of strong collagen fibers.
3) Stroma: a collagen layer that comprises the majority of the cornea.
4) Descemet’s membrane: a thin layer of tissue that protects the eye from infection and holds the endothelium in place.
5) Endothelium: the thin, innermost layer of the cornea. It is made up of cells (endothelial cells) that are responsible for pumping water out of the cornea.
If you are a candidate for transplant, we will discuss your particular condition, the reason for your vision loss, and the specific type of surgery we recommend.
Different Types of Transplants
There are two broad types of cornea transplants: full-thickness and partial thickness.
A full-thickness transplant – Penetrating Keratoplasty (PK) – replaces all five layers of the cornea (Epithelium, Bowman’s Layer, Stroma, Descemet’s Membrane, and Endothelium).
Over the past 15 years, tissue-targeted surgical approaches have been developed. Endothelial Keratoplasty (EK) was developed specifically for conditions of endothelial dysfunction (Fuchs’ Dystrophy, pseudophakic, aphakic bullous keratopathy), and the goal is to replace the endothelium (innermost layer of the cornea) while leaving the surface and stroma intact. There are two commonly performed EKs: Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) and Descemet’s Membrane Endothelial Keratoplasty (DMEK).
Another type of partial transplant is called Deep Anterior Lamellar Keratoplasty (DALK), which replaces the three outermost layers of the cornea (Stroma, Bowman’s layer, and Epithelium) while preserving the two innermost layers of the cornea (Descemet’s membrane and Endothelium).
What to Expect if You are Going to Receive a Corneal Transplant
This information has been developed to contribute to the success of your surgery. You and your loved ones should use this material as you prepare for surgery as well as for future reference. If you have additional questions, please do not hesitate to ask. We are here to help you.
Before Surgery
Blood samples, EKG, and/ or chest X-rays are required to clear you for surgery. Some testing depends upon your age and health status.
Due to the pandemic, a COVID-19 test is required 72 hours prior to surgery.
You may be asked to stop certain medications prior to surgery.
The Day Before Surgery
On the day before surgery in the morning or early afternoon, our office will call to let you know whether an appropriate donor cornea has been found. If a donor cornea is available, then a nurse from the hospital will call to tell you what time to arrive for surgery. You should expect this second call in the late afternoon or early evening.
In preparation for surgery, you are not allowed to eat or drink anything after midnight on the night before surgery.
Obtaining a Donor Cornea
At present, the only source of corneal tissue is from a donor who has willed their cornea for transplantation, or whose family has donated the cornea after the donor’s death. It may be upsetting to think about death as a source of replacement tissue, but for most families the opportunity to give sight to another human is comforting.
All corneas are screened for HIV and Hepatitis, as well as other infectious diseases. We receive corneas through The Eye Bank, and the waiting period for a cornea is usually 4-6 weeks. Surgeries are tentatively scheduled with the hospital or surgicenter, and the actual surgery will only occur if there is a suitable donor cornea available. If no suitable cornea is available, the surgery can be rescheduled soon after the original date.
The Day of Surgery
Corneal transplant surgery is normally done on an outpatient basis, and you should expect to be at the hospital for 5-6 hours. We ask that you make arrangement for someone to drive you home afterwards.
Click here for directions to our surgery centers
When you come for surgery, please bring all your medications in their originally labeled bottles (if possible).
After check-in, a nurse will interview you about your general state of health. Please provide information on any known allergies.
Later, an anesthesiologist will perform their own screening.
Most corneal transplant surgeries are performed under local anesthesia.
If local anesthesia is used, then just prior to surgery the physician will inject medication around your eye. This medication will temporarily prevent pain, movement, and vision.
During Surgery
Eye drops, including antibiotics, will be administered.
Sterile drapes will be placed to isolate the eye having the surgery.
Adequate ventilation will be provided.
The transplant will typically take 1-1.5 hours.
To assure that your donor cornea remains secure, very fine stitches (called sutures) will be placed with the aid of a microscope around the outer edge of your cornea.
A patch and protective shield will be placed over the operated eye when surgery is complete.
If local anesthesia is used: you will be awake but anesthetized during the procedure. Inform the physician or nurse if you happen to feel any pain or become nauseous during surgery.
If general anesthesia (less frequent) is used, then you will awaken in the recovery room, where you will stay for about an hour before being moved to a hospital room.
Right After Surgery
You will stay in the hospital for at least an hour after surgery. During this time, you will be able to walk to the bathroom with the assistance of nursing personnel and sit for meals.
If an Endothelial Keratoplasty (EK) was performed, then there will be an air bubble in the eye; positioning – lying on your back as much as possible – will be very important.
If local anesthesia was used, you can resume your regular diet.
If general anesthesia was used, you will receive liquids for your first meal and can resume a regular diet the following day.
The eye dressing that was placed after surgery will remain in place until the morning following the surgery, when you will have your first post-operative appointment. Try to keep the eye closed.
The Day After Surgery
During your first post-operative appointment, the patch and protective shield will be removed and your eye will be examined. Afterwards, it is important that you protect the eye at all times – either with glasses or the shield – for at least one month. We ask that you sleep with the shield on for at least one week.
If an Endothelial Keratoplasty (EK) was performed and you have an air bubble in the eye, then you will be instructed on how to position your body in order to increase your chances of successful recovery.
Also at your first post-operative appointment, antibiotic, steroid, and sometimes dilating drops will be administered to prevent infection and rejection of the donor cornea. Unless otherwise told, you may resume all regular systemic medications (except Aspirin – wait two days before restarting).
Eye pain following a corneal transplant is usually minimal, and Tylenol can be taken if necessary. Do not use Aspirin, Advil, or Motrin for at least two days.
Let us know if you have sudden, severe, or persistent pain.
Post-Transplant Cornea Care
Eye Drops
Antibiotic and dilating drops will be prescribed for one month.
Steroid drops may be prescribed for at least one year.
Click here for the proper technique to administer eye drops
If you do not have enough eye medication at home, call us at (212) 305-3378 or (914) 723-1641 with the name of the medication and the phone number of your pharmacy. Please plan ahead if your drops are running low, and try to avoid running out in the evening or on a weekend or holiday. It is important that you receive every dose of your medication, so please tell us about any barriers to getting your medication so that we can work with you to find solutions.
Hygiene
You may clean around your eye, but do not rub the eye.
You may shower and shampoo your hair, but try to keep water and soap from getting into the eye.
If there is crusting, use a clean, wet washcloth to gently wipe the eye once or twice a day. Never put the washcloth into the eye or use the same part of the washcloth twice. Avoid putting any pressure on the eye. Do not rub the eye.
Return to Activities
You can return to school or work if it does not involve strenuous activity or lifting.
You can also perform light housework, however do not lift, push, or bend with your head lower than your heart.
You can read, watch TV, and/or do needlework until the eye becomes tired.
You can also drive a car, so long as the corrected vision in the un-operated eye is 20/40 or better.
Until approved by the doctor, please refrain from:
Any strenuous activity that causes you to become red in the face (as straining increases pressure in the eye). This includes lifting.
Participating in sports
Bending into any position where your head is lower than your heart
Other
If it is necessary to cough or sneeze, please do so with your mouth open.
At times, a flu shot vaccination may increase the risk of cornea transplant rejection. Patients who plan on getting a flu shot before surgery or any time after surgery should notify their doctor. Drops may sometimes be prescribed or altered before you receive the flu shot.
Click here to download general post-operative instructions
The Possibility of Corneal Rejection
Your corneal transplant will most likely be successful, however there is a possibility your body will reject the new cornea. Please click here to read more about the possibility of corneal rejection.
Writing Your Donor Family
Receiving the gift of sight is a very special gift, and many donor families find great comfort in knowing that their donation has improved the lives of others. We encourage cornea transplant patients to send a thank you to their donor families.
Click here to read more
The information contained within these pages is intended for informational purposes only and does not take the place of consulting a physician.
Created by and for New York Cornea, with offices at Columbia University Medical Center and in Scarsdale, New York.
Caring for your corneas since 1988.