Corneal transplantation can help improve vision only in cases of corneal blindness. It doesn't help cases with damaged retina or optic nerve. The whole eye is never changed and its only the front part (Cornea) which is transplanted.

Corneal transplant may be required after eye injuries or in various eye diseases such as ….

• Scarring and opacification Cornea due to eye injury or secondary to infections such as corneal ulcer, herpes of the eye etc.
• Keratoconus and other similar diseases which involves thinning of the Cornea causing irregularity in its shape.
• Hereditary diseases of the cornea.
• Corneal failure (Bullous Keratopathy) from previous surgeries or injuries. This causes fluid collection, swelling and blistering of the cornea.
• Complications of Excimer laser surgeries.
• Chemical burns on the cornea.

Apart from the eye disease itself, other factors should also be taken into account before proceeding towards corneal transplant. These include......

• Does the functional vision impede the patient’s daily living and professional activities? The vision in the better or unaffected eye and the profession of patient should be considered.
• Can the vision be corrected by special contact lenses or other less invasive surgeries?
• Will the patient be able to follow a prolonged and strict follow-up schedule after surgery?
• Will the patient be able to report early to a medical facility in case of symptoms of graft rejection?

All of these questions must be answered along with a thorough discussion with the eye surgeon before final decision is made to have a corneal transplant.

Waiting for a donor

Once it’s decided that a corneal transplant is required, the patient’s name is listed at an eye bank and transplant centre. The Eye Bank collects eyes from donors and processes the tissue for surgical use. The corneal tissue is checked for clarity and any diseases. The donor is also meticulously screened for diseases such as hepatitis, syphilis and HIV to ensure the health and safety of the recipient.

NO. You cannot buy or sell human organs as per Indian laws. The eye bank can only charge a reasonable processing fees to cover the cost of procuring and checking the tissue. The donor eye itself is invaluable

Corneal transplants are usually done as daycare procedures and takes approximately 1-2 hours. Local or general anaesthesia may be used, depending on the patient’s health, age and personal preferences. For local anaesthesia, an injection is given around the eye to numb it and temporarily paralyse the eye muscles.

In the most common procedure called 'penetrating keratoplasty', the surgeon replaces a round, button-shaped section from the central part of cornea with a nearly identical button from the donor tissue. The donor cornea is held in place with multiple very fine sutures. In some cases cataract removal and implantation of IOL may also be required.

Corneal Graft with sutures

Other surgical variations such as DSEK, DMEK, DALK, ALTK have come up over the years to tackle some of the problems associated with the classic technique of penetrating keratoplasty. The time duration of surgery remains similar.

Sutureless Transplant

Immediately after surgery, the eye is patched for a few hours. During the initial few weeks, there may be some discomfort including pain, grittiness, intolerance to light and watering. The vision is blurry initially but gradually improves over few weeks. The rate of visual recovery is usually much faster with sutureless techniques such as DSEK or DMEK.

The doctor usually prescribes multiple eye drops to prevent infection and help in the 'acceptance' and healing of the graft. Initial follow-ups are very frequent - sometimes every day. After the first 1-2 weeks, the follow-up frequency is gradually reduced.

The patient can start their day to day activities within a few days. However restarting normal professional activities may take longer - sometimes a few weeks depending on the job profile and the status of the other eye.

Heavy exercise and lifting are prohibited for the first few weeks. The patient also has to maintain strict hygiene related precautions to prevent infection in the eye.

Corneal transplant requires life long followups and care. To understand the importance of long term care, its important to read and understand the next section about Graft Rejection.

Steroid eye drops are be prescribed for several months to years to prevent graft rejection. Stitches are usually removed slowly over many months starting usually from three months after surgery.

Even though corneal transplant improves vision, the total recovery time may be upto an year. Visual recovery is much faster with newer sutureless techniques such as DSEK and DMEK. However these techniques cannot be used in all cases. In most patients correction with glasses or contact lenses is required for optimal vision. Since the vision usually fluctuates during the first few months and changes after every suture removal/adjustment, it is desirable to wait for some time for the final prescription of glasses.

After healing is complete and stitches are removed, laser vision correction (LASIK or PRK) can also be done in some case to reduce dependence on glasses or contact lenses.

Rigid Gas Permeable (RGP) contact lenses, provide the best vision correction after corneal transplant because these compensate for the irregularity of the cornea after transplant. Soft contact lenses are also an option in some cases.

Graft Rejection

The body’s immune system protects the body from harmful external agents. The crucial first step in this process is differentiation between 'self' and 'other'. In any transplant, the body sees the new organ as "foreign" or external. This triggers an immune response which if not controlled in time leads to damage of the new organ. The same thing happens in a corneal transplant where the body sees the new cornea as foreign and attempts to destroy it.

Since a normal cornea doesn't have any blood vessels, it reduces the chances of  rejection. But it can still happen in a quarter of cases. It most frequently happen in the first 1-2 years but can occur anytime after surgery. If not treated in time, it leads to permanent damage to the graft requiring re-surgery. Recognition of the warning signs and timely treatment is the best way to prevent a complete graft rejection.

Symptoms of graft rejection

RSVP refers to the acronym for the common symptoms of graft rejection. These are:

• Redness
• Sensitivity to light
• Pain
• Visual Blurring

Graft rejection should be urgently treated with high dose steroids as eye drops,  injections or tablets. If treated in time, almost complete recovery of cornea can happen.

To reduce chances of problems associated with the traditional "Penetrating Keratoplasty" (full thickness graft), newer techniques have been developed. These techniques improve visual recovery, reduce chances of graft rejection, reduce need for long term medications and frequent doctor visits. Most of these surgeries utilize lamellar techniques where only a particular layer of cornea is changed instead of the full thickness. However the surgeon needs to check for suitability of these advanced techniques for each patient.

There can be no contact between the donor and the recipient. Their identities cannot be revealed to each other. The best way to thank these good citizens is carry forward this legacy and be an eye donation champion yourself. Click here to know more about the process of eye donation

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