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Cataract
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What is Corneal Transplant Surgery? The eye is constructed like a camera and functions in much the same manner. The main functioning parts of the camera are the protective front lens, the focusing lens, the shutter,and the film. The eye has corresponding parts which function in a similar manner.
FIGURE I The CORNEA is the forward-most portion of the eye. It is the main "window" of the eye. It is like the protective lens of the camera. The cornea is what you usually "poke" when you stick a finger in your eye! The cornea and the lens of the eye are the main focusing apparatus of the eye. Damage to the cornea can cause a normally crystal clear cornea to turn white or gray. If this happens, you can no longer see through it and vision may be lost (unless surgery is performed to restore it). The IRIS is behind the cornea. The hole in the iris is the PUPIL. The iris and pupil become larger and smaller in different lighting conditions to let different amounts of light into the eye like a shutter on a camera. The LENS of the eye is like the lens of the camera in that it focuses light coming through the cornea and through the iris onto the back portion of the eye. The VITREOUS is a thick jelly-like fluid behind the lens which keeps the eye round and semi-soft. The RETINA is a thin membrane at the back of the eye which acts like the film of the camera. It takes pictures which have been focused by the cornea and the lens and sends them to the brain on the NERVE of the eye, the OPTIC NERVE. WHY YOU MAY NEED A CORNEAL TRANSPLANT There are many conditions
for which a person might need a corneal transplant. CORNEAL TRANSPLANT When the cornea becomes "opaque" or gray/white from disease or injury or painful from swelling or blisters, it no longer functions as the "clear window" of the eye. It then acts more like a "soapy" window which you cannot clearly see through. Even if the rest of the eye is healthy, a cloudy cornea will obstruct clear vision. Corneal transplants are the most successful transplant in the body with success rates from 85-95%.The procedure itself is technically difficult. It is performed under an operating microscope which magnifies the eye 30 to 60 times. . The diseased cornea or "host" cornea, is cut with a round blade with a hole in its center. This is like a round cookie cutter punching a round disc of cookie dough. The diseased tissue or disc is removed just as you would pick up the cut out cookie, leaving a rim of cookie dough on the platter. Now you have a hole in the center of the cornea just like the hole in the center of the cookie dough. The surgeon then uses the same or a slightly larger blade to cut a similar piece of tissue from a HEALTHY CORNEA from a person who has recently died. This healthy "donor" cornea is then placed into the hole where the diseased tissue was removed. The healthy, new piece of corneal tissue is then sewn to the remaining rim of the patient's tissue as shown in the drawing.
The eye then has a healthy, CLEAR "NEW WINDOW" or corneal transplant. The stitches remain in place for 12 months and vision usually begins to return in 1 to 8 weeks after surgery. It must be remembered however, that diseases of other portions of the eye, such as disease of the lens or of the retina, can limit the final vision even if the surgery was successful and the cornea is perfectly clear. Other procedures such as cataract extraction and lens implant, intraocular lens implant removal or vitrectomy may be and often are performed at the same time as the CORNEAL TRANSPLANT. COMPLICATIONS Despite the most advanced surgical techniques and the most expert surgeons, complications can and do occur. The most serious complications are uncommon and the lesser complications are usually treatable. Those risks include but are not limited to: loss of vision, loss of the eye itself, loss of vitreous, irregular pupil, retinal detachment, macular edema, wound leaks, infection, malposition or later movement of the intraocular lens, inability to place the intraocular lens, hemorrhage in (expulsive) or behind (retro-bulbar) the eye, glaucoma, rejection, graft failure, high post-operative astigmatism, the need to wear glasses/contact lenses even after surgery, the need for later astigmatism surgery,or repeat transplant, unexplained poor vision, permanent leaving in of the sutures, intermittent suture rupture and removal, double vision, lid droop, and unknown complications which could lead to loss of vision or loss of the eye at the time of surgery or in the future. If your eye becomes red, painful, mattery, or the vision changes after surgery, please call us immediately even if it is a weekend, night or holiday! HOSPITALIZATION When a cornea becomes available, you will be called and asked to go to the hospital in one or two days. Depending on your age and physical condition, an internist may be asked to perform a full physical examination on you. The surgery can be performed under LOCAL OR GENERAL anesthesia. The surgery can be done as an outpatient or you can be in the hospital for 1 to 2 days after the surgery based on your and your doctor’s preference.You should be up and around the morning after surgery. POSTOPERATIVE CARE When you are discharged
from the hospital, you will be given bottles of eye drops and possibly
some pills. They will be labeled and it is extremely critical that they
be used as directed. It is crucial that you NEVER run out of medicine. If you do, call us or your pharmacy and we will arrange for refills of your medications. It will be necessary for you to be seen by your surgeon daily for 3 days after surgery, then weekly for 4 to 6 weeks, and then monthly for 3 to 4 months. THESE ARE IMPORTANT VISITS AND MUST BE KEPT! THE DONOR TISSUE AND THE EYE BANK Donor corneas are so named because they must be donated at the time of death. These corneas are retrieved by the local eye bank , which has waiting lists from the doctors who use the eye bank.The lists tend to be fairly long and at any given time as many as 30-50 people may be waiting for a corneal transplant. Since they are performed in order, according to the list, there can be a 1 to 3 month waiting period for a corneal transplant . We look carefully at all the corneas offered and use only those that appear to be the healthiest. There is a service fee which is charged by the eye bank for the donor cornea. This fee is used to cover the cost of the technician and for screening tests on the donor for potentially transferable illnesses such as hepatitis, aids, rabies etc. These fees are usually covered by your insurance or Medicare. FEES AND INSURANCE It is always a good idea to find out how much the surgery will cost and how much Medicare or your insurance will pay. THERE ARE NO FEES FOR BEING PLACED ON THE WAITING LIST, AND NO SURGICAL CHARGES ARE REQUESTED PRIOR TO THE SURGERY. IF THE SURGERY IS PAID FOR WITHIN 30 DAYS after the insurance payment, THERE IS A FEE REDUCTION. Therefore, please ask our staff if you are interested in such an arrangement. Our staff is always willing to answer questions and assist you with forms.
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