Corneal Transplantation

Corneal transplantation or penetrating keratoplasty is a surgery to remove the diseased cornea and replace with a donated one. The surgery is considered a type of organ transplantation. The success rate is
70-95% (Le R, et al., 2017), depending on the patient’s condition and disease.

Which eye conditions may eventually lead to requiring a corneal transplantation?

Corneal Transplant
  • Penetrating keratoplasty
  • Lamellar keratoplasty involves selective removal and replacement of diseased corneal layers, reducing risks associated with a full corneal transplant and requiring smaller incisions.
    • Upper anterior/upper layer corneal transplant By changing the cornea from the corneal epithelium, Bowman layer, and corneal stroma.
    • Endothelial keratoplasty involves selective removal and replacement of from the lower stroma, Descemet's membrane layer, and corneal endothelium.
Phototherapeutic keratectomy (PTK) involves using an excimer laser in treating several corneal disorders including hereditary corneal dystrophy, anterior corneal scarring, and uneven corneal surface. 

Corneal collagen cross-linking involves the use of the ultra-violet A to treat keratoconus by strengthening collagen fibers in the cornea, thereby keeping the cornea from bulging more and stabilizing or improving vision. 

In an intrastromal corneal ring segment implant, certain rings are placed in the deep, peripheral corneal stroma in order to stabilize the corneal shape and strengthen the cornea structure.
Corneal transplantation is considered a major surgery of the eye. It might cause emotional concerns to the patient due to anxiety, stress, depression, anger, or disappointment. However, they are rare and the patient will undergo extensive evaluation by the physician both physically and emotionally before the surgery.
  1. The main purpose is to improve the patient’s vision.
  2. To strengthen the cornea when the old one was too thin or perforated.
  3. To control corneal infection.
  • During the surgery: accidental injury on the innermost layer of the cornea, iris, intraocular lenses, vitreous hemorrhage, and the worst is hemorrhage underneath the retina.
  • First phase after the surgery: sutures leakage, flat anterior chamber, prolapse of the iris, sutures abscess, permanent defect cornea, ocular hypertension, and infection that is harmful to the vision.
  • Second phase after the surgery: astigmatism, unhealed sutures, central serous chorioretinopathy (CSC), previous disease recurrence, and glaucoma.
  • Cloudy cornea:
  • If cloudy cornea occurs the first day after the surgery, it is possible that the donor cornea is defected, or might be caused by the surgical injury.
  • If it becomes cloudy later on, it is likely that the donor cornea is rejected as the body’s immune system tries to eliminate the foreign body. Graft rejection could possibly occur from week 2 to 1 year after the surgery. Other symptoms include less vision, redness, irritation, tearing, and sensitivity to light. Cortisol Steroid is always recommended for treatment.
Before the Procedure
  • Please plan to stay in Thailand for at least two weeks to one month through the duration of your treatment. (This does not include a waiting period for the cornea.)
  • It is recommended that you stay in a hotel close to the hospital for convenience in traveling to the hospital before and after the procedure.
  • You will undergo a health screening when convenient for you before the procedure as the procedure is done using general anesthesia. You will likely need to fast before the health screening. You will be given detailed instructions by your medical team.
After the Procedure
  • You will return to see your doctor after one to two weeks for post-operative assessment before you are cleared to return home and/or get on an airplane. Your doctor will determine if it is safe for you to travel.
The success of the procedure depends on a number of factors including:
  1. The patient’s cornea i.e. previous history, the cornea’s condition.
  2. The patient himself i.e. the current illness, post-operative care.
  3. Other complications such as glaucoma, retina disease, and uveitis.
An ophthalmologist specializing in cornea will assess your eye condition and provide the information on the success rates of the treatment after the assessment.
The surgery
You will be evaluated by the ophthalmologist and medical physician before the surgery to make sure you are well enough to undergo anesthesia. The surgery takes approximately 1-2 hours. The ophthalmologist will remove the diseased cornea with 7-8 millimeter diameters whilst a button of a little bigger size is also cut from a donor’s cornea. The donor tissue is then sewn in place with extremely fine nylon sutures.
Lamellar keratoplasty
Only the anterior layer of the cornea with pathology will be removed. With the remaining layers of the cornea, graft rejection risk is decreased. However, lamellar keratoplasty is a more complicated procedure.
Lamellar keratoplasty candidates
  • Cornea has been damaged from the previous surgery such as cataract surgery
  • Keratoconus
  • Genetic damage of the cornea
  • Wounded cornea caused by injury or infection
  • Graft rejection of the previous transplantation

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