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Corneal Transplant

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.

Thank you for trusting your eyecare with us over the years.  The Foresight Eyecare team follows the government mandate to reduce the spread of the COVID-19 pandemic.  After December 2020 announcements made by the Alberta Government, our clinic is following the revised Infection Prevention and Control policy by the Alberta College of Optometrists.

Patients interested in obtaining eye exam services or eye care products can be seen by appointment only.  Please call ahead, and staff will arrange an appointment time and ask COVID-19 screening questions.  If you have any symptoms of cough, fever, runny nose or shortness of breath, we ask that you call or e-mail us and do not attend the clinic for your scheduled visit.   Within the clinic, please wear a mask and use the hand sanitizer at reception.  Our clinic complies with the City of Calgary bylaw requiring mask covering over the age of two years old.  For patients who are unable to wear a face covering due to medical reasons, the patient can be scheduled for an appointment at a time when minimal number of other patients are in the clinic such as at the beginning or end of the day to ensure appropriate physical distancing requirements.

We are using disposable disinfectant wipes on all surfaces and devices such as front desk counters, chairs, handles in exam rooms and waiting room.  All eyewear that have been touched by patients are continually being sanitized.   Any toys and magazines are stored at this time.  Examination areas are being sanitized with hospital grade disinfectant.  Debit and credit cards but NO CASH payments will be accepted.

COVID-19 symptoms are not always obvious.  We want to fend off this pandemic and minimize risk to our patients and the Foresight staff as front line health workers.   Contact that is closer than 2 m (6 feet) is to be avoided, with barriers in place when this cannot be avoided. We choose to continue to do our work and cautiously take care of our patients with compassion, humility, gentleness, and patience.   It is a challenging and new experience for many of us, so let‘s support each other and prevent virus spread!  Beyond 2020, our focus is on take care of you and keeping Clean Hands, Clear Heads and Open Hearts.   For more information, please refer to the following web pages or phone Health Link 811.

www.albertahealthservices.ca

www.collegeofoptometrists.ab.ca

Drs. Dianna Leong, Anh Bui, Andrew Chan