Understanding Corneal Transplant Surgery
Corneal Transplant Video
In 2005 and 2006, Dr. Tim Khater performed a corneal transplant surgery on Bryan Hughes, the weatherman for Fox 34 News. Bryan's right eye was transplanted in 2005, and his left eye was transplanted in 2006 for a condition known as keratoconus, where the front part of the eye is misshapen. In Bryan's case, his eyes were bad enough where he was unable to see well enough with glasses or contacts.
After his successful right eye surgery, Bryan is seeing 20/20 with the aid of a contact lens. Currently, Bryan is healing well in his left eye, and will be soon fitted with another contact lens for it. To see the videos, please click on the Fox 34 logos. There are 2 videos: video 1 and video 2.
Corneal transplant surgery is quite common; some 5,000 transplants are done in the United States every year. In recent years, the chances of success of this operation have risen dramatically because of new advances such as the surgical microscope, finer, less irritating sutures, and better eye banking techniques. In fact, many patients can expect better than a 90% chance of a clear transplant. Even though this surgery is a unique and sometimes frightening experience for you as a patient, we hope that this section will help to guide you through this new experience by answering questions concerning corneal transplant surgery and your role in ensuring its success.
What is the Cornea
Corneal transplant surgery involves removing the diseased cornea
surgically and replacing it with a donated cornea. To help you better understand this, let
us briefly describe just what the cornea is.
Light is Scattered by Corneal Clouding or Irregularity
Obtaining a new cornea is what happens in corneal transplant surgery. This operation is sometimes called corneal graft surgery or penetrating keratoplasty. We will use the term corneal transplant surgery. Your eye is the recipient eye; the other person's cornea is the donor cornea or donor tissue.
The Donor Cornea
The donor tissue for our corneal transplant surgery is provided by the Great Plains Lions Eye Bank. Eye banks have existed in this country since 1946. Through the efforts of the Lions and the Great Plains Eye Bank, thousands of Texas citizens have signed pledges indicating that, upon their death, their corneas are to be used for transplant operations. Even without the pre-arranged pledge, the nearest relative may give permission for this use of the eye tissue upon death.
The eye bank receives information regarding the availability of the eye donations, arranges for the collection and distribution of the tissue, and notifies the ophthalmologist with patients listed for surgery that the operation can be scheduled. There is no charge for the donor tissue, but the costs of operating an eye bank are quite high and patients receiving corneal transplants are asked to pay a service fee to help defray expenses.
You might be curious to know something about the donor of your corneal transplant; it is the policy of all eye banks that the donor remains anonymous. Certain general points might be of interest. Donors between the ages of 5 and 75 are considered acceptable if the tissue has been obtained promptly and passes the careful screening procedures. Sex, race, blood type, nearsightedness farsightedness, and eye color are not considered in selecting the donor because they do not affect the outcome of the corneal transplant surgery.
The donated corneas are carefully screened for transmittable disease, including AIDS and hepatitis B. Although there has never been a case of AIDS reported from a transplanted cornea, all donor tissue is screened for AIDS and rejected if positive. Indeed, if any of the known transmittable conditions are suspected by medical history or screening examination, the cornea is rejected and disposed of.
One of the most valuable recent advances is the technique for storing donor corneas in fluids for several days. This protects the donor corneas, allows for better planning and timing of surgery, and is one of several important factors that improve chances of successful surgery.
We perform the surgery while looking through a microscope in order to do this very delicate work with great precision. A trephine, an instrument like a cookie cutter, is used to remove your cloudy cornea. A trephine cuts out the donor graft to ensure that its size and shape are right for the opening made in your cornea. Bleeding is minimal, amounting usually to only one or two drops of blood.
The new corneal transplant is placed in the opening and is sewn or sutured with a very fine thread, often finer than a human hair. This thread or suture stays in for months or even many years until your eye heals properly; in some instances the suture is left in permanently. Removing the suture is quite simple and can be easily done in the office.
Corneal transplant surgery is routinely performed with either local or general anesthesia. The best method for you will be discussed with you by Dr. Khater.
If the surgery is performed under local anesthesia, you will be temporarily put into a light sleep with an intravenous medication; the local anesthesia will then be injected in the area around the eye. In most instances, patients do not feel or even remember this injection. Afterwards, your eye will be totally numb and the surgery can be performed while you are awake, but lightly sedated.
If the surgery is performed under general anesthesia, you will be put to sleep, and a plastic tube will be placed in your windpipe to breathe for you. Again no eye pain will be experienced.
Both methods of anesthesia are carefully monitored by an anesthesiologist, and both methods can be done on an outpatient basis.
Caring for your corneal transplant after surgery depends, in large measure, on you. We must work together well, and you must follow strictly the instructions on how to care for your precious new transplant. You will need to use eye drops for many months (or years), and we, or your referring ophthalmologist, will need to see you regularly in the office. There will be certain restrictions on your activities in the early period after your surgery. These will be explained later.
Chances of Success
In most cases the successful outcome following corneal transplant surgery depends on the type of corneal disease that was originally present. When the eye receiving a corneal transplant is perfectly healthy except for cloudiness of the central cornea, the chances of a clear transplant are greater than 90%. But to be successful, you must follow the strict schedule of drops and office visits. Failure to follow the prescribed schedule could greatly reduce the chances of successful surgery. Here are some problems that could delay or prevent the return of useful sight in your operated eye.
Primary Transplant Failure: Fortunately, this is rare. It occurs in the first week or two after surgery and is caused by a fault in the donor cornea. The only treatment is to do another transplant with a different donor cornea.
Graft Rejection: This is quite unusual. It happens when the body becomes "allergic" to the graft and can occur at any time two weeks or more after surgery. There is a good chance that this can be successfully treated if you act immediately. There are four danger signs that you must know. If any of these occur and last for more than six hours, you should immediately call us. These signs are:
Wound Separation: This is a break in the area where the edge of the graft is sewn into the eye. There might be no symptoms at all or only a dull ache. It may be treated with a light patch or soft contact lens or it may require a trip back to the operating room so that additional suturing of the transplant can be done.
Astigmatism: This occurs when the transplanted corneas has an oblong shape similar to the surface of a football rather than the round shape of a basketball's surface. All transplants have some amount of astigmatism and usually this can be corrected with glasses or contact lenses. If this astigmatism is severe, a refractive procedure can often correct it.
Loose Suture: This is not uncommon. Sometimes during the healing process sutures can loosen and case a foreign body feeling, especially when you blink. The loose suture can easily be removed in the office.
Macular Edema: This is a swelling from fluid that has collected in the retina in the back of the eye. It occurs most commonly if the eye has previously undergone cataract surgery. The only symptom is a painless loss of vision. This fluid cannot be surgically drained, but the condition often improves on its own or may respond to certain pills and eye drops that we prescribe.
Considerations Before Your Surgery
Outpatient vs. Inpatient Surgery
Our experience with outpatient corneal transplant surgery indicates that it is as safe for most patients as inpatient surgery, and it certainly is less stressful. Most patients can now arrive at the hospital on the morning of surgery and leaves within one hour after surgery has been completed. We do our outpatient corneal surgery in the same quality operating suites that we use for inpatients, and so you have the benefits of the highly-skilled nurses and superb facilities of The Methodist Hospital combined with the convenience of lower cost of outpatient surgery.Of course, we do admit those patients who for medical reasons require it, but we find that most of our patients can benefit from outpatient surgery.
Planning Postoperative Care
If you have a referring ophthalmologist, our staff will be happy to schedule your postoperative visits with that ophthalmologist. We are happy to provide postoperative care for as long as your referring doctor wishes.
Postoperative visits are routinely scheduled for the following intervals after your surgery: 1 day, 5-7 days, 3 weeks, and 6 weeks. This may vary according to your particular circumstances. Subsequent visits are usually at monthly or bimonthly intervals during the first year after surgery.
If you live too far away to have follow-up care with us, and you have no referring ophthalmologist, then we will be happy to work with you to find an ophthalmologist near your home who can provide you with your postoperative care.
Your personal eye care after your surgery will mainly involve putting eye drops into the operated eye for several months or longer, beginning with 4 times a day and then at gradually decreasing intervals. We find that almost all individuals can learn to put drops in their own eyes. If, however, this is not possible for you, please be sure to arrange for someone to help you use the eye drops at home.
General Medical Precautions
If you have medical problems that require the care of a physician, a recent written report from you physician would be helpful to us. If you doctor has a preference concerning the use of local vs. general anesthesia in your case, please let us know. In most cases we will use local anesthesia; that is, you will be awake during the operation.
Stop taking any medication containing aspirin 7-10 days before surgery. If you are taking a "blood thinner" such as Coumadin, this will need to be stopped a few days before surgery: please check with your doctor for exact instructions. Also, please consult with your doctor concerning when and if you should stop taking any other medications. Bring all medications that you are currently taking when you come for your office visit on the day before surgery.
If you experience fever or infection in any part of your body within 2-3 weeks of your scheduled date of surgery, it is likely that we will want to reschedule the surgery for a later date. In such an event, check with your general medical doctor and/or this office for a decision about rescheduling.
Your Vision After Surgery
In the months following surgery the vision in your eye will slowly improve. This improvement is variable because the healing of the corneal transplant varies from patient to patient. In general, useful vision can be obtained within two to six months. About this time, you may be given a prescription for glasses or a contact lens. As your corneal graft heals, your prescription for glasses will probably change.
The suture holding your graft in place is usually allowed to remain in the eye for a year or sometimes longer. When the suture is removed, a substantial change in your eye glasses prescription will occur. This suture can easily and painlessly be removed in the office.
Even after the suture is removed, you should always see an ophthalmologist following your corneal transplant surgery. You will need to use eye drops for a year or sometimes more depending on your particular situation.
Instructions for Patients Recovering from Corneal Transplant Surgery
Special Eye Care Precautions
Bathing and Hair-washing
|First week after surgery - You may return to all normal, nonstrenuous activities. Avoid hard straining and resume sexual relations cautiously.|
|Six weeks after surgery - Sports such as jogging, swimming, and golf may be resumed. Sexual relations may be resumed without restrictions.|
|More vigorous activities such as racquetball sports (tennis, squash, and racquetball) and diving should be avoided for at least six months following surgery. Please check with us before resuming these activities.|
|In the vast majority of patients, recovery is uneventful. Different people react differently to corneal transplant surgery. Some irritation, such as a scratchy sensation with occasional sharp pain or movement of the eye, is expected during the first week or two following surgery and is a usual accompaniment of healing. Occasionally however, a sudden change in symptoms can occur which should alert you to have your eye checked. You should contact your doctor immediately if you experience any of the following:|
Your attention to details, correct use of medications, and regular return for follow-up examinations are vital for the recovery of your eye.