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Corneal Transplants

The cornea refers to the clear, front surface of your eye. When a corneal transplant is done, officially termed keratoplasty (KP), the central part of the cornea is surgically removed and replaced with a “button” of clear and healthy corneal tissue donated from an eye bank.

According to the National Eye Institute, approximately 40,000 corneal transplants are performed annually in the United States. The overall success rate for keratoplasty is relatively high, yet up to 20% of patients may reject their donor corneas. Aggressive medical treatment with steroids is generally given in response to signs of rejection, and it is often effective at subduing the negative reaction and saving the cornea. At five to ten years after KP surgery, studies report an encouraging success rate of 95% to 99%.

Why are corneal transplants done?

Corneal transplants are typically done when the cornea becomes damaged or scarred in a way that uncorrectable vision problems occur. These types of vision conditions are not resolved by eyeglasses, contact lenses or refractive laser surgery (such as LASIK). Disease or injury is the usual culprit for the vision loss.

Keratoconus is a common reason for needing a corneal transplant. In this degenerative condition, the cornea thins and bulges forward in an irregular cone shape. Rigid gas permeable (GP) contact lenses can treat mild cases by flattening the cornea, yet contacts are not effective when it comes to advanced stages of keratoconus. The National Keratoconus Foundation reports that 20% to 25% of people with keratoconus will require corneal transplant surgery to restore vision. Other corneal degenerative conditions will also result in a need for keratoplasty.

Corneal ectasia is a thinning and bulging of the cornea that sometimes occurs after LASIK or other refractive vision correction procedures. In the event that this happens, a corneal transplant may be needed to restore vision.

Corneal scarring, due to chemical burns, infections and other causes, is an additional reason that a corneal transplant may be indicated. Traumatic injuries to the eye are also commonly responsible.

Corneal Transplant Procedure

Keratoplasty is generally done on an outpatient basis, with no need for overnight hospitalization. Depending upon age, health condition and patient preference, local or general anesthesia is used.

Using a laser or a trephine, this is an instrument similar to a cookie cutter, the surgeon cuts and removes a round section of damaged corneal tissue and then replaces it with the clear donor tissue.

Extremely fine sutures are used to attach the donor button to the remaining cornea. The sutures remain in place for months (sometimes years) until the eye has recuperated, healed fully and is stable.

Recovery from a Corneal Transplant

The total healing time from keratoplasty may last up to a year or longer. At first, vision will be blurred and the site of the corneal transplant may be inflamed. In comparison to the rest of the cornea, the transplanted portion may be slightly thicker. For a few months, eye drops are applied to promote healing and encourage the body to accept the new corneal graft.

A shield or eyeglasses must be worn constantly after surgery in order to protect the healing eye from any bumps. As vision improves, patients may gradually return to normal daily activities.

What happens to vision post-keratoplasty?

Some patients report noticeable improvement as soon as the day after surgery. Yet a great deal of astigmatism is common after a corneal transplant. A patient’s prescription for vision correction tends to fluctuate for a few months after the surgery, and significant vision changes may continue for up to a year.

Hard, gas permeable contact lenses generally provide the sharpest vision after a corneal transplant. This is due to a residual irregularity of the corneal surface. Even with rigid contact lenses, eyeglasses with polycarbonate lenses must be worn in order to provide adequate protection for the eye.

Once the sutures are removed and healing is complete, a laser procedure such as LASIK may be possible and advised. Refractive laser surgery can reduce astigmatism and upgrade quality of vision, sometimes to the point that no eyeglasses or contact lenses are needed.

PROTECTING OUR COMMUNITY

We have been working very hard to prepare to re-open for normal "routine" preventive eye care, taking every precaution to ensure the safety of everyone involved. We are pleased to announce as of Monday May 18th we'll be seeing patients for all types of eye care, including routine annual eye exams.

But, things will be very different than they were prior to the pandemic.

1. Our front door will be locked at all times. We will be allowing only 1 person at a time in the office and by appointment only, so please enter alone, or with no more than l other person accompanying you. Others may wait in the car.

2. Masks will be required for both patients and us while in our office.

3. Upon entering, we will be checking your temperature and screen you for COVID symptoms or possible exposure. If your temperature is 100 F or higher, or you have symptoms or may have recently been exposed to COVID, we will reschedule you.

4. We will need you to respect the 6 feet personal distancing while outside the exam room

5. We will have you wash your hands for 20 seconds or use hand sanitizer when you enter. We will be using hand washing and hand sanitizer constantly and will be disinfecting everything you and we touch. Please don't touch anything that isn't absolutely necessary.

6. For frame selection or picking out glasses, please let us help you, and don't just browse and try on frames by yourself. We have to disinfect the frames every time they are touched or worn, and we need to know which frames need to be disinfected.

We are doing all these things to protect you and all of our other patients as best we can. We will need and depend on your cooperation on this during this very difficult time. Doing so will protect your fellow patients-many of whom are at extremely high risk if they contract COVID - and to protect us. All healthcare providers are putting themselves in harm's way every day during this pandemic - the more we all cooperate and take appropriate precautions, the better off we all will be.

We are all in this together. Thank you for your patience, understanding, and cooperation.

Please stay safe.

Dr. Jim Hutchins and staff