A guide to corneal transplant surgery, from preparation to recovery.
What is the cornea?
The cornea is the clear window at the front of the eye. It allows light to enter the eye and does most of the focusing for the eye.
The cornea must be clear to allow light to pass into the eye. It must also have a regular curve to properly focus the light. Injury, disease or inherited conditions can impair the cornea and interfere with vision.
What is a corneal transplant?
A corneal transplant is an operation that aims to restore or improve vision. It replaces a disc-shaped segment of an abnormal cornea with a piece of healthy donor cornea. It is performed in a hospital or day surgery. Most patients can go home the same day. Corneal transplants may be full-thickness (penetrating keratoplasty) or partial thickness (lamellar keratoplasty), replacing either the front or the back of the cornea.
Of all transplant surgeries done today, corneal transplants are the most common. Overall success rates are better than 90 per cent after one year, and 74 per cent at five years.
Reasons for transplants
Corneal transplant is a treatment option for eye diseases that cause the cornea to become cloudy, lose transparency or change shape. This happens in diseases such as bullous keratopathy, Fuchs' endothelial dystrophy, and keratoconus.
Other reasons for corneal transplant include:
- eye injury from sharp objects or chemicals
- eye infection from viruses or bacteria
- clouding of the cornea at birth
How do I get on the transplant list?
Your ophthalmologist will assess if a corneal transplant is the best treatment option to improve your vision.
If a transplant is needed, your ophthalmologist will put your name on the New Zealand Eye Bank's surgery schedule.
The date of the surgery will be determined by:
- the availability of the surgeon, anaesthetist and operating theatre
- your preferred date
- the New Zealand Eye Bank's estimate on the availability of a donor cornea for a particular date
How much does it cost?
If you choose to have your transplant through the private health system, you should discuss all costs with your ophthalmologist.
While it is illegal to buy or sell human eyes, organs and tissues, the New Zealand Eye Bank is allowed to recover their costs involved in the eye donation and providing their service.
Before surgery you will need to complete a range of tests. These may include blood and urine tests, ultrasounds, x-rays, electrocardiograms and further eye tests. You will also need to provide consent for surgery. This will be arranged by your ophthalmologist.
The hospital will inform you of the details of the operation including:
- when to stop eating and drinking before surgery
- what to bring along
- any medication requirements before admission
Most patients can go home the same day. But you may need to prepare for an overnight stay.
On the day of surgery
The surgery requirements, tissue requirements and expected outcomes are different for each patient.
Contact your surgeon or the place of surgery to get information about your particular procedure.
After surgery, you will be cared for in recovery until you can be safely discharged.
When you leave the hospital or day surgery, you will receive information on:
- what to expect
- physical restrictions that could affect the transplant (e.g. heavy lifting)
- pain relief or other medication requirements
- emergency contact details and a follow-up appointment time
Most patients will go home the same day of surgery with an eye-patch. You will likely need to return for a follow-up review the next day.
The initial recovery period after corneal transplant is between one and three weeks. During this time you will need to follow the instructions for recovery and attend follow-up appointments.
Discuss resuming daily activities, like driving, with your surgeon to make sure it is safe to do so.
It is important to recognise that this surgery is transplant surgery. Recovery of vision is highly dependent on the underlying disease process and how your body functions. It can vary from a few days to a few months.
Like organ transplants, success of a corneal transplant is not guaranteed. It is important to discuss the risks of corneal transplant and expected outcomes with your ophthalmologist.
Warning signs after surgery
Like any transplant surgery, there is a chance that your body may reject the donated cornea. If a transplant does fail, you can try the procedure again.
If you experience any of the symptoms below, it could indicate transplant rejection or other issues. It is important to seek medical assistance immediately.
Redness of the eye
Your eye will be red for the first few weeks after surgery, but this will lessen with time. If there is a substantial increase in redness, or redness after the recovery period, contact your ophthalmologist.
Some light sensitivity after surgery is expected. It should gradually decrease. If your eye becomes more sensitive to light than usual, contact your ophthalmologist.
After surgery, you should test your vision at home every day. Changes in vision are expected but if your vision becomes cloudier or blurrier, contact your ophthalmologist.
Small twinges of pain during the healing process are expected. But inform your ophthalmologist if your eye hurts or throbs steadily for more than a couple of hours.