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Keratoplasty: Procedure, Results, Complications For Keratoplasty

Nov 14, 2023

Keratoplasty: Procedure, Results, Complications For Keratoplasty

During a corneal transplant, a part of the cornea is replaced with donor corneal tissue. This process is also known as keratoplasty at times. The cornea is the transparent, dome-shaped surface of the eye. Light enters the eye through the cornea. It has a major impact on the eye's ability to see clearly.

A corneal substitute might:

  • Restore your vision.
  • Reduce pain.
  • Enhance the appearance of a cornea that is infected or damaged.

Most corneal transplant surgeries succeed. However, donor cornea rejection can occasionally cause a corneal transplant to go wrong. Corneal transplants are the most common way to restore vision to someone who has damaged corneas. Furthermore, a corneal transplant can relieve pain and other symptoms associated with corneal diseases.

Many conditions can be treated with a corneal transplant, including:

  • Keratoconus, a cornea that bubbles outward.
  • Fuchs dystrophy is a genetic condition.
  • Tear or thinning of the cornea.
  • Corneal scarring resulting from injury or illness.
  • Growth of the cornea.
  • Corneal ulcers are not responding to medical intervention.
  • Repercussions from previous eye surgery.

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How do you prepare For Keratoplasty?

Before receiving a corneal transplant, you are going to:

  • A detailed eye checkup. Your ophthalmologist looks for conditions that may cause complications after surgery.
  • The measures of your eye. Your eye doctor will decide what size donor cornea you need.
  • A  list of every medication and dietary supplement you take at the moment. It may be necessary to cease using some medications or supplements before or after your corneal transplant.
  • Therapy for other ocular problems. Infections or other ocular conditions like edema can reduce the success rate of a corneal transplant. Your eye doctor will take care of such matters before your treatment.

Also Read: Retinoblastoma: Causes, Symptoms, Diagnosis, Treatment, Prevention And Complications

Methods For Keratoplasty

In a corneal transplant, healthy donor tissue replaces damaged corneal tissue, either completely or partially. Your corneal surgeon will decide which course of action is optimal. These procedures include the following:

  • Penetrating keratoplasty: This treatment includes a full-thickness corneal transplant. After the surgeon has cut through the entire thickness of the damaged or irregular cornea, a little disc of corneal tissue the size of a button is removed. This neat circular cut is made with a specialized tool.
    • After it has been adjusted to fit, the donor cornea is inserted into the opening. After that, the replacement cornea is secured in place using stitches commonly known as sutures, used by your surgeon. Your eye doctor may decide to remove the stitches at a later appointment.
  • Endothelium-based keratoplasty: Endothelial keratoplasty comes in two types. During these operations, harmful tissue in the back corneal layers is removed. Among the layers are the endothelium and the Descemet membrane, a tissue layer that is attached to the endothelium. The lost tissue is replaced with tissue from donors.
  • The initial type of operation, called Descemet stripping endothelial keratoplasty (DSEK), replaces up to one-third of the cornea with donor tissue. A considerably thinner layer of donor tissue is used in the second type of treatment, called Descemet membrane endothelial keratoplasty (DMEK). The tissue used in DMEK is extremely thin and sensitive. While being used more frequently, this approach is more difficult than DSEK.
  • ALK stands for anterior lamellar keratoplasty: Damaged tissue is extracted from the stroma and epithelium of the anterior corneal layers using two distinct techniques. Nevertheless, the posterior endothelium layer is not eliminated by them. The kind of ALK operation that is best for you depends on the extent of corneal damage. In superficial anterior lamellar keratoplasty, the cornea's anterior layers are the only parts that are fixed.
  • A deep anterior lamellar keratoplasty, or DALK, is used when corneal damage extends further into the stroma. After that, healthy tissue from donors is used to restore the corneal portion that was removed. This process is known as "grafting."
  • Transplanting of artificial corneas: If a corneal transplant with a donor cornea is not an option for you, you might receive an artificial cornea. This procedure is called keratoprosthesis. Your doctor will go over the best course of action for you in terms of corneal transplant surgery, including the associated risks and what to expect along the way.

Also read: Eye Floaters: Causes, Symptoms, Risk Factors, Diagnosis and Treatment

Results Of Keratoplasty

The majority of corneal transplant recipients will see some improvement in vision. The purpose of the treatment and your health will determine what to anticipate following a corneal transplant.

Even years after obtaining a corneal transplant, you are still vulnerable to problems like ocular rejection. For this reason, see your eye doctor once a year. Corneal rejection is frequently treated with medication.

Corrective Lenses After A Procedure

It's possible that after surgery, your vision will be worse than it was before. Your eye needs some time to adjust to the new cornea. The improvement of your vision may take several months. After surgery, the outer layer of your cornea could not heal for a few weeks or months. When it recovers, your eye doctor will make the following adjustments to improve your vision:

  • Correcting any corneal abnormalities: The stitches used to hold the donor cornea in your eye may cause your cornea to become uneven. This uneven surface could lead to astigmatism. A person with astigmatism may have fuzzy vision. To cure the astigmatism, your ophthalmologist might choose to remove a few stitches.
  • Taking care of vision problems: It is possible to correct refractive defects, such as nearsightedness and farsightedness. Your ophthalmologist may recommend glasses, contacts, or, in certain cases, laser eye surgery.

On the day of your corneal transplant, you will be given medication to numb your eye and to help you feel less anxious or afraid. Your unique situation will determine how long you need to spend in the operating room.

Also read: Myopia: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

What Methods Should Be Followed After Keratoplasty?

After receiving a corneal transplant, you should:

  • Take your medicine: Eye drops and other drugs can be used to treat pain, edema, and infections. Immune system inhibitors for the eyes help prevent corneal rejections.
  • Put on safety glasses: Using glasses or an eye cover, you might be able to protect your injured eye while it heals.
  • Give it your all: Depending on the type of transplant, this recovery period may take different lengths. This promotes the attachment of the new tissue.
  • Avoid injury: Make sure you recuperate gradually following your corneal transplant. After receiving the all-clear from your ophthalmologist, gradually resume your regular schedule, which should include working out. Avoid pressing or rubbing your eye. You will need to take special care to protect your eyes for the rest of your life.
  • Schedule regular checkups: Make sure to schedule regular check-ups with your eye doctor during the year after surgery. This is to monitor your progress and look for any problems.

Also Read: Stye: Causes, Symptoms, Risk Factors, Diagnosis and Treatment

Complications Of Keratoplasty

Cornea transplant surgery is generally safe. However, there is a remote possibility of serious adverse effects, like:

  • Irritated eyes.
  • Glaucoma, an increase in intraocular pressure.
  • Problems with the sutures used to secure the corneal donation.
  • Turning down the corneal donor.
  • Retinal problems include retinal detachment and edema.

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