Our eyes are like two windows that open to the world, right? But sometimes these two windows start to become blurry and unclear. Due to an accident, infection, or some medical conditions, the transparent, thin membrane at the front of our eye can be damaged. This part, which works like the lens of a camera, is called the 'cornea'. When this cornea is damaged, our vision can be almost completely lost. So today we are going to talk about 'Cornea Transplant', which surgically removes such a damaged cornea and transplants a healthy cornea in its place, allowing many people to see the world clearly again.
Simply put, what is a corneal transplant?
A corneal transplant is also called a 'corneal transplant surgery'. It is also called ``Keratoplasty'' in English. What happens in this is very simple. Your damaged, diseased cornea is carefully removed by an eye surgeon. Then, a completely healthy corneal tissue donated by a deceased person is transplanted in its place.
It's like removing an old, scratched watch glass and replacing it with a brand new one. After the surgery, light will start to enter your eye properly again, and your blurred vision will become clearer. This is truly a life-changing surgery.
Who should undergo this surgery?
There are several situations in which your eye doctor may suggest this surgery. Not everyone needs it. It is mainly considered if the cornea is damaged and it is significantly affecting your vision.
Here are some of the main reasons:
- Fuchs' dystrophy: This is a genetic condition. The cells in the inner layer of the cornea are gradually destroyed. This causes the cornea to swell and blur vision.
- Keratoconus: In this condition, the cornea thins and bulges forward in the shape of a cone. This causes severe distortion of vision.
- Corneal ulcers: Severe infections can cause sores (ulcers) on the cornea. Even if these sores heal, they can leave scars and permanently impair vision.
- Accidental injuries: If something hits the eye, something sharp pierces it and damages the cornea.
- Damage from previous eye surgery: Sometimes, the cornea can be damaged after other surgeries, such as cataract removal.
- Bullous keratopathy: This is a condition in which the cornea swells and blisters form on the surface. This can cause eye pain and vision loss.
If you have this condition, your doctor is the one who will examine you and make the best decision about whether or not you need a corneal transplant.
Are there different types of these surgeries?
Yes, absolutely. Unlike in the past, technology has advanced so that you can choose the right surgery based on the extent of damage to your cornea. Our cornea has three main layers of tissue. The type of surgery depends on which of these layers is being treated.
Take a look at this information. Then you can get a better idea about this.
| Type of surgery | What is simply happening? |
|---|---|
| Full-thickness corneal transplant (Penetrating Keratoplasty - PK) | This is the traditional method. Here, the entire thickness of the cornea, that is, all three layers, is removed, a healthy cornea of the same size is transplanted, and it is fixed using fine stitches. |
| Deep Anterior Lamellar Keratoplasty (DALK) | If the inner layer of your cornea is healthy, this surgery can be performed. In this procedure, only the damaged outer and middle layers are removed and healthy tissue is transplanted in their place. Since your own inner layer is left, the risk of rejection by your body is reduced. |
| Endothelial Keratoplasty (DSAEK/DMEK) | If the damage is only to the inner layer of the cornea (endothelium), this surgery is performed. Here, only the thin layer that is damaged is removed and a healthy layer is transplanted in its place. This involves very few stitches. |
The specialty of endothelial transplantation
In both `DSAEK` and `DMEK` surgeries, doctors use a little trick to hold the newly transplanted membrane in place inside the eye. That is, they insert an air bubble into the eye. Imagine, like when we put a poster on a wall and hold it down for a while, this air bubble pushes the new membrane from inside the eye. Then it sticks and stays in place.
For this reason, the doctor advises you to lie down with your face up (face up) as much as possible for a few days after the surgery. This will allow the air bubble to settle into place and do its job properly.
How do you prepare before surgery?
There is a little preparation before surgery. It is very important to be aware of these things in advance.
- Talking to the doctor: Your doctor will ask about your complete medical history. Be honest about any other illnesses you have, medications you take, and allergies.
- Stopping Medications: Sometimes, you may be asked to stop taking certain medications, such as blood thinners, a few days before surgery. Always do this as directed by your doctor.
- Fasting: You will be told how many hours you need to fast before surgery. After that time, do not eat or drink anything.
- Transportation: You will not be able to drive yourself after surgery, so make arrangements in advance to have someone drive you home.
What to expect after surgery?
The surgery usually takes less than two hours. You will then be taken to an observation unit and allowed to go home shortly after. You will need to take special care of these things after you go home.
- Eye Patch: When you come home from the hospital, you will be given an eye patch. You should wear it for exactly the number of days your doctor tells you. This will protect your eyes.
- Pain and discomfort: In the first few days, your eyes may be slightly red, itchy, and sensitive to light. This is normal. You can take painkillers prescribed by your doctor.
- Follow-up: The doctor will want to see you again within 24-48 hours after surgery. There, the patch will be removed and the eye will be checked for healing.
- Eye Drops: You will likely be given several types of eye drops to help your eye heal. These include antibiotics to prevent infection, and corticosteroids to reduce swelling and prevent the body from rejecting the transplanted cornea. It is very important to use these medications exactly on time and for the full duration prescribed .
- Things to avoid: Avoid strenuous activities, such as heavy lifting, bending, etc. that can cause eye strain. Avoid any risk of getting anything in your eye.
- Do not rub your eyes: Do not rub or squeeze your eyes for any reason . Doing so may interfere with healing and damage the transplanted cornea.
What are the benefits and risks of this surgery?
Like any surgery, a corneal transplant has benefits as well as certain risks.
Main advantages
The main benefit is the restoration of clear vision . Many people can easily resume their daily activities, such as reading and watching television, after this surgery. For some, this surgery also helps reduce eye pain.
Possible complications
The biggest and most serious risk of a corneal transplant is organ rejection.
Our body's immune system is like an army in a country. It thinks anything that comes from outside is an enemy and attacks it. So sometimes, our body thinks this newly implanted cornea is also a 'foreigner' and starts working against it. This is what we call rejection.
To reduce this risk, you need to use eye drops for a long time.
In addition, other complications that may occur include:
- Eye infection
- Bleeding
- Increased eye pressure (Glaucoma)
- Fluid leakage from the transplanted cornea
- Detached retina
- Vision problems due to irregular curvature of the cornea (Astigmatism)
What are the symptoms if the body rejects the cornea?
This is the most important part you need to remember . If your body rejects your transplanted cornea, recognizing the symptoms and getting treatment early can help save your sight. Keep these signs in mind:
- Eye pain: New onset of pain.
- Redness: The eye becomes redder than usual.
- Cloudy vision: Vision becomes blurred again.
- Sensitivity to light: Feeling too uncomfortable to look at light.
If you experience any of these symptoms, call your eye surgeon immediately. Don't delay. If treatment is started early, it is very possible to reverse this rejection process.
How long does it take to fully recover?
The time it takes for this to happen will vary depending on the type of surgery you had.
- If a full-thickness graft (PK) is performed, it can take up to 12 months to regain full vision, as even the stitches are removed after a while.
- If an endothelial transplant (DMEK/DSAEK) is performed, good vision can be achieved within as little as 3 months .
It's best to talk to your doctor about things like driving and going to work and make a decision based on his or her advice.
Take-Home Message
- A corneal transplant is the replacement of a damaged cornea with a healthy one. This can restore blurred vision.
- Your eye surgeon will choose the type of surgery that is best for you.
- Following the doctor's instructions after surgery, especially the use of eye drops, is essential for the success of the surgery.
- Always be on the lookout for signs of rejection, such as eye pain, redness, recurring blurred vision, or sensitivity to light. If you notice any of these, tell your doctor immediately.
- It takes time to fully recover, so it is important to be patient and follow your doctor's instructions.
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