What is Corneal Transplant

A corneal transplant, also known as keratoplasty, is a surgical procedure in which a damaged or diseased cornea is replaced with a healthy cornea from a donor. The cornea is a transparent tissue located at the most front of the eye which helps focus light and contributes to clear vision.

WHO NEEDS A CORNEAL TRANSPLANT?

Several conditions can affect the cornea, leading to vision impairment that cannot be corrected by glasses, contact lenses, or other non-surgical treatments. Some of the common reasons for needing a corneal transplant include:

  • Keratoconus: Cornea becomes thinner, steeper and bulges outward into a cone shape.
  • Fuchs’ dystrophy: A disease which builds up fluid and results in corneal swelling.
  • Corneal scarring (due to injury or infection).

TYPES OF CORNEAL TRANSPLANT

1. Full-thickness (Penetrating Keratoplasty): The entire thickness of the cornea is replaced. This type of transplant is done when the damage affects both the front and inner cornea.

Full-thickness_corneal_transplant_(PKP)_graphic_replacing_all_corneal_layers

2. Partial-thickness (Lamellar Keratoplasty): Only the front and the middle of the cornea is replaced. This may be done for conditions affecting only the outer layers of the cornea, such as certain corneal dystrophies.

Diagram_of_DALK_procedure_replacing_outer_corneal_layers_in_a_partial-thickness_transplant

3. Endothelial Keratoplasty: A newer and minimal invasive type of transplant that replaces only the inner layer of the cornea (the endothelium).

Illustration_of_DMEK_corneal_transplant_showing_thin_inner_layer_replacement

THE PROCEDURE

Here’s an overview of how the surgery works:

  1. Local anesthesia: Before the surgery, eye drops will be instilled to numb the eye.
  2. Removal of the Damaged Cornea: The surgeon will remove the host’s cornea using a special surgical instrument, leaving a small rim of tissue to hold the donor cornea in place.
  3. Donor Cornea Placement: Surgeons use fine sutures or air bubbles to attach the donor tissue to the eye. The sutures will be left in place for weeks to months to allow for proper healing.
  4. Recovery and Follow-up: The healing process can take several months, during which time the patient will need to attend follow-up appointments to ensure the transplant is successful and to monitor for complications.

POSSIBLE COMPLICATIONS

Graft rejection occurs when the body’s immune system sees transplanted tissue as something that shouldn’t be there and tries to get rid of it. This can occur in 3 out of every 10 patients transplanted.

Warning signs of your body trying to reject your cornea transplant include:

  • Redness
  • Sensitivity to light
  • Hazy vision
  • Eye pain

Should you experience such symptoms after a transplant, see your corneal surgeon immediately. Your ophthalmologist might be able to stop the rejection with medicine.

CONCLUSION

If you or someone you know is struggling with vision problems due to corneal issues, a consultation with an ophthalmologist can help determine if a corneal transplant might be a viable solution. 

The corneal surgeons available in OasisEye Specialists include Dr Vanitha Ratnalingam who is based in Kuala Lumpur and Penang; and Dr K John Mathen who is based in Kuala Lumpur.

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Types of Corneal Ulcer

Corneal ulcer is an inflammation of the cornea secondary to infection. It will cause red eyes, pain, excessive tearing, blurred vision and light sensitivity. Corneal ulcer can be caused by bacteria, viruses, fungi and parasites. If left untreated or if infection is severe, corneal ulcer can lead to permanent damage of vision.

Bacterial keratitis

Bacterial infections are the most common cause of corneal ulcer. Most of the time Pseudomonas Aeruginosa, Staphylococcus species and Streptococcus species are responsible for this type of infection. Bacterial keratitis can develop quickly. There is a high risk of getting infection from long hours of wearing contact lenses or not taking care of them correctly. Thus, proper care of contact lenses will reduce the risk of developing a corneal infection.

Close-up_of_an_eye_with_a_severe_corneal_ulcer,_showing_a_white_cloudy_spot_and_redness.

Fungal keratitis

Improper use of contact lenses or steroid eye drops can lead to fungal infection. A corneal injury that results in plant material like being hit by a tree branch also will cause fungal keratitis which is mostly due to Fusarium or Aspergillus species. Candida species will typically cause keratitis in the eye with preexisting ocular surface disease or eyes that have recently been treated with topical steroid. Fungal keratitis is devastating, hard to treat and remains a common cause of blindness in tropical countries.

Eye_with_herpes_simplex_keratitis,_featuring_a_branching_corneal_lesion_and_redness.

Herpes simplex keratitis

Herpes keratitis is a viral infection caused by herpes simplex virus. It may cause recurring attacks and be very contagious when contact with someone who has the virus. After primary infection, the virus lies in a dormant state, living in the nerve cell of the eye. It can be triggered by stress, trauma, fever or certain medications.

Acanthamoeba keratitis

Lastly, parasitic infection caused by Acanthamoeba is a rare, vision threatening corneal ulcer. Acanthamoeba is a microscopic, single-cell living organism and can be found in freshwater and soil. People who wear contact lenses develop higher risk of getting Acanthamoeba keratitis when they clean lenses with tap water, swimming while wearing contacts or contact with contaminated water. Early diagnosis and treatment of Acanthamoeba keratitis is essential to prevent loss of vision.

An ophthalmologist will be able to assess your eye and diagnose the type of corneal ulcer/infectious keratitis you have. All these conditions may cause severe pain and impaired vision. Therefore, corneal ulcer/infectious keratitis may need serious medical attention and should be treated immediately to prevent the conditions from worsening.

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