Corneal Transplant (Penetrating Keratoplasty)

A surgical procedure to remove the diseased part of the cornea and replace it with a similarly sized and shaped part of a healthy donor cornea.

Corneal transplantations are performed for several reasons, including the following:

• Optical: To improve the optical qualities of the cornea to improve vision by replacing a scarred cornea with a healthy, clear one.
• Reconstructive: To reconstruct a perforated cornea to preserve the eye in its whole form.
• Therapeutic: To treat a disease unresponsive to medical management such as uncontrolled fungal corneal ulcers or to alleviate the pain of a severe foreign-body sensation due to recurrent ruptured blister-like lesions in Bullous Keratopathy.

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Common Indicators
Bullous Keratopathy, Fuchs' Endothelial Dystrophy, Keratoconus, Repeat Graft, Keratitis, Viral or Bacterial Problems, Fungal Ulcers, Perforations, and Corneal Stromal Dystrophies are the most common indications for a corneal transplant.

Surgical Technique
Corneal transplants can be performed using general or local anesthetic plus intravenous sedation. To prepare the tissue for transplantation from the donor cornea, the surgeon punches out a corneal button from the central part of the donor cornea using a trephine. To create the recipient bed to receive the donor corneal button, the surgeon removes the central 60 to 80% of the host cornea using a trephine and scissors. The donor corneal button, which is trephined slightly larger than the recipient bed, is then sutured in place.

Postoperative Management
Postoperative topical antibiotics are used for several weeks and topical corticosteroids for several months. In some patients, fuzzy vision caused by corneal astigmatism can be reduced in the early postoperative period by suture adjustment or selective suture removal. Achievement of full visual potential may take up to 1 yr because of changing refraction, slow wound healing, and/or corneal astigmatism. In many patients, earlier and better vision is attained with a rigid contact lens over the corneal transplant. To protect the eye from inadvertent trauma after transplantation, the patient wears shields, glasses, or sunglasses. In addition, patients are advised to avoid bending over completely, lifting heavy objects, or straining.

Prognosis
The corneal transplant is not only the oldest transplant performed, but also the most common transplant performed. The prognosis for a clear, functioning corneal transplant varies by diagnosis. The chance of long-term transplant success is higher than 94%, according to the Eye Bank Association of America. The generally high rate of success of corneal transplantation is attributable to many factors, including the effectiveness of the immunosuppressive drugs used to treat graft rejection. If you have any concerns, contact your Ophthalmologist. Your doctor will be able to inform you of the risks and rewards of the corneal transplant.