A corneal transplantation is an ophthalmological surgery in which the cornea is replaced with another one from a donor. Corneal transplantation can be used to improve the appearance of a damaged or diseased cornea, to reduce eye pain caused by other corneal disorders, or to restore vision.
The procedure has a success rate of over 90%, but there are also certain complications. Find out what corneal transplantation involves, how it is performed, and which patients need it.
What is corneal transplantation?
The cornea is the transparent surface, located in the front part of the eye. Light enters the eye through the cornea, and the cornea helps to focus the light and form the image on the retina. When the cornea is affected, the patient experiences eye pain and blurred vision.
Corneal transplantation is the surgical procedure in which this component of the eye is replaced. The specialist removes the damaged cornea and replaces it with healthy corneal tissue.
For most patients, corneal transplantation is effective as it restores vision and improves quality of life.
When is a corneal transplantation necessary?
Most commonly, a corneal transplantation is performed when the patient has a damaged cornea. Furthermore, the procedure can relieve pain or other symptoms of corneal disorders.
Several ophthalmological conditions that can be treated with a corneal transplantation include:
- Keratoconus (when the cornea bulges outward)
- Fuchs’ dystrophy (a genetic condition)
- Thinning or tearing of the cornea
- Scarring of the cornea (caused by infection or injury)
- Inflammation of the cornea
- Corneal ulcers that do not respond to ophthalmological treatment
- Complications caused by previous ophthalmological surgeries
What are the risks of corneal transplantation?
Like with any surgical procedure, there is a risk of complications when it comes to corneal transplantation. These may include:
- Eye infection
- Increased pressure inside the eye (glaucoma)
- Issues related to the sutures used to secure the new cornea
- Bleeding
- Retinal problems, such as retinal detachment or inflammation
- Rejection of the donated cornea
The immune system may mistakenly attack the donated cornea. Rejection may require medical treatment. Rejection occurs in approximately 10% of corneal transplantations and may require medical treatment or another corneal transplantation.
Despite the risks, the majority of corneal transplantations are successful for at least 10 years after the procedure.
How do you prepare for a corneal transplantation?
The first step in scheduling a corneal transplantation is a thorough ophthalmological examination, in which the specialist examines the cornea and discusses your medical and family history to ensure that the intervention is the most appropriate treatment option. The specialist will also inform you about the possible risks involved in the surgery and your obligations during the recovery process.
Another important aspect will be reviewing the medications and supplements you are taking (if applicable). It is possible that you may need to interrupt certain treatments before or after corneal transplantation.
It is possible for the doctor to treat other minor ophthalmological problems before the transplant (e.g. corneal inflammation or eye infection). This is to ensure that there is nothing that could reduce the chances of corneal transplantation.
Finally, the ophthalmologist will take measurements of the cornea to determine the size the donor corneal tissue must have.
The corneas used in this procedure come from deceased individuals whose causes of death are known. Corneas from persons who have had previous ophthalmological interventions, vision problems, or transmissible diseases are not used.
Corneal transplantation: Surgeries
In a corneal transplantation, either the entire section or only a part of the cornea is removed and replaced with healthy tissue. The surgeon will choose the safest and most effective method. There are several types of corneal transplantation:
- Penetrating keratoplasty: This surgery involves a full corneal transplant. The surgeon removes the diseased cornea and replaces it with a healthy one. The specialist then uses sutures, also known as stitches, to sew the new cornea. The stitches will be removed during a postoperative examination.
- Endothelial keratoplasty: DMEK (Descemet Membrane Endothelial Keratoplasty) is an advanced method of partial corneal transplant, in which only the posterior part (endothelium and Descemet’s membrane) of the patient’s cornea is replaced. This portion is extremely thin (approximately 10-15 microns).
- Anterior lamellar keratoplasty: It is a procedure in which only a part of the patient’s cornea is removed and replaced. There are two types of anterior lamellar keratoplasty: SALK (which replaces only the superficial layers of the cornea, leaving the healthy stroma and endothelium intact), and Deep DALK (which involves removing deeper layers of the cornea – the stroma – but preserving the endothelium).
- Artificial corneal transplantation: Patients who are not eligible for a corneal transplantation with a donor cornea can receive an artificial cornea. This surgery is known as keratoprosthesis.
Recovery after corneal transplantation
- Usually, after corneal transplantation, the doctor will prescribe you a treatment. Eye drops and other medications can prevent infections and reduce inflammation and discomfort. Additionally, immune-suppressing eye drops help prevent corneal rejection.
- You may be advised to lie on your back. This helps keep the new tissue in place, but it depends on the type of transplant.
- Furthermore, the doctor may suggest wearing protective glasses to protect your eyes from screens during the recovery period.
- It is important to gradually return to your daily activities, especially when it comes to sports.
- Do not press on your eyes and do not rub your eyes. It is essential to avoid any injuries to the eyes.
- In the first year after the surgery, you must attend regular check-ups. This is so that the doctor can monitor your progress and detect and treat any potential complications in a timely manner.
Initially, your vision may appear weaker than before the transplantation, but the eye needs time to adapt to the new cornea. It may take several months for your vision to improve.
It is possible for the ophthalmologist to make certain adjustments to improve your vision quality:
- Correcting irregularities in the cornea: The sutures that hold the cornea in place can cause irregularities in the cornea. If the surface is not uniform, you may develop astigmatism. In this regard, the doctor may remove some sutures to correct the irregularities in the cornea.
- Correcting refractive errors: Refractive errors such as myopia and hypermetropia can be corrected. The ophthalmologist may recommend glasses, contact lenses, or refractive surgery.
How much does a corneal transplantation cost?
The price of a corneal transplantation in Romania is determined after an ophthalmological examination, depending on the patient’s medical needs.
The price range is between lei 19,437 and 22,919/eye [*article written in January 2024]. Usually, the surgery itself costs lei 7,000, to which the cost of the graft (the donor cornea) is added. Depending on the chosen method, the graft can cost euro 2,500 or euro 3,200. The fee is paid in lei, at the exchange rate of the National Bank of Romania on the day of payment.
The price of the corneal transplantation generally includes postoperative check-ups in the first month after surgery and corneal tomography, if necessary.
It is important to mention that prices may vary depending on the clinic, type of intervention, and other specific aspects of each case. We recommend contacting the clinic directly for accurate and up-to-date information.
If you have had a corneal transplantation and experience any of the following symptoms, contact your ophthalmologist immediately:
- Eye pain
- Redness
- Blurry vision
- Sensitivity to light
- Eye discharge
- Fever