Generality/Definition
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In corneal transplant, also known as keratoplasty, a patient's damaged cornea is replaced by the cornea from the eye of a human cadaver. This is the single most common type of human transplant surgery and has the highest success rate. Eye banks acquire and store eyes from donor individuals largely to supply the need for transplant corneas. The cornea is the transparent layer of tissue at the very front of the eye. It is composed almost entirely of a special type of collagen. It normally contains no blood vessels, but because it contains nerve endings, damage to the cornea can be very painful.
Source: Corneal transplantation (healthatoz.com)
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A corneal transplant involves replacing a diseased or scarred cornea (the clear dome-shaped surface that covers the front of the eye) with a new one. When the cornea becomes cloudy, light cannot penetrate the eye to reach the light-sensitive retina. Poor vision or blindness may result. In corneal transplant surgery, the surgeon removes the central portion of the cloudy cornea and replaces it with a clear cornea, usually donated through an eye bank. Corneal transplantation has restored sight to many, who a generation ago would have been blinded permanently by corneal injury, infection, or inherited corneal disease or degeneration.
Source: Corneal Transplantation (iueye.iu.edu)
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Every year, hundreds of infants are born throughout the world with genetic diseases that cause opacities or cloudiness of the cornea (the window of the eye). Opacified corneas prevent light impulses from reaching the brain, which results in permanent blindness. But blindness may be prevented in these infants through the use of cornea transplant surgery.In this procedure, the opacified cornea is replaced with a donor cornea. This provides a new clear window that allows light impulses to be transmitted to the brain so that visual development may occur.
Source: Pediatric Corneal Transplantation (laser-prk.com)
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Epidemiology
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The chances of success of this operation have risen dramatically because of technological advances, such as less irritating sutures, or threads, which are often finer than a human hair; and the surgical microscope.
Source: Corneal Transplantation (iueye.iu.edu)
Diagnosis
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Corneal transplantation is recommended for:
Inherited corneal thinning (keratoconus) with visual distortion, for scarring of the cornea from severe infections or injuries , for inherited or acquired corneal clouding (Fuch's dystrophy) with visual loss.
Source: Corneal transplant (nlm.nih.gov)
Treatment
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In a corneal transplant, a disc of tissue is removed from the center of the eye and replaced by a corresponding disc from a donor eye. The circular incision is made using an instrument called a trephine. In one form of corneal transplant (penetrating keratoplasty), the disc removed is the entire thickness of the cornea and so is the replacement disc. Over 90% of all corneal transplants in the United States are of this type. In lamellar keratoplasty, on the other hand, only the outer layer of the cornea is removed and replaced. An eye shield or glasses must be worn to protect the eye until the surgical wound has healed. Eye drops will be prescribed for the patient to use for several weeks after surgery. These drops include antibiotics to prevent infection as well as corticosteroids to reduce inflammation and prevent graft rejection. For the first few days after surgery, the eye may feel scratchy and irritated. Vision will be somewhat blurry for as long as several months.
Source: Corneal transplantation (healthatoz.com)
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Prior to surgery the patient is given laboratory tests that may include blood and urine tests, ultra-sounds, X-rays, electrocardiograms and further eye tests. Patients are instructed not to eat or drink anything eight hours prior to their scheduled surgery. In most cases the surgery is performed as a day procedure and will not require an overnight stay in hospital. Cornea transplant surgery may be performed under general or local anesthesia. The patient's face is cleansed and prepared and covered with sterile operating sheets. So fine is the surgery that the surgeon performs the operation looking through a surgical microscope.The patient's own diseased or damaged cornea is removed with a cylindrical cutting instrument. The donor's cornea is cut similarly so the shapes are indentical. The clear, healthy donor cornea is placed in the opening where the patient's old cornea was removed. The donor cornea is then sewn into place with sutures (stitches) that are less than half the thickness of a human hair.
Source: Corneal Transplantation (iris.medoph.unimelb.edu.au)
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Most corneal transplant operations are done under local anesthesia on an outpatient basis. This means that the patient is awake but an injection is given to make the eye completely numb. There is no pain. The corneal tissue for transplantation is taken from a donor shortly after death with the permission of the next of kin. Though most transplant procedures carry the risk of rejection of the transplant tissue or organ, the cornea has very limited blood supply, which greatly reduces this risk. Most corneal transplants function extremely well for many years.
Source: Corneal transplant (nlm.nih.gov)
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Cornea transplant surgery in children is very complex and technically far more challenging than adult corneal transplantation because of the fragile nature of infant tissue and the difficulty in visual rehabilitation in infants. Indeed, only a handful of surgeons in the world feel comfortable performing corneal transplants on infants because of the possibility of poor results, technical difficulties, and the enormous commitment needed to visually rehabilitate these patients.
Source: Pediatric Corneal Transplantation (laser-prk.com)
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Information for specialists
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The Cornea-Genetic Eye Medical Clinic is one of the few facilities in the western United States dedicated to pediatric corneal transplantation and research to improve the ultimate visual outcomes in these extremely complex cases. This unique facility benefits from having access to excellent pediatric anesthesia, state-of-the-art technology, and one of the most sophisticated genetic divisions in the world the Medical Genetics-Birth Defects Center at Cedars-Sinai Medical Center, Mark Goodson Building.
Source: Pediatric Corneal Transplantation (laser-prk.com)
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