What is a Corneal Transplant?
A corneal transplant, also known as keratoplasty, is a surgical procedure that replaces damaged or diseased corneal tissue with healthy donor tissue.
The cornea is the transparent, dome-shaped surface covering the front of the eye, essential for focusing light and maintaining clear vision. When the cornea becomes scarred, swollen, or irregularly shaped due to injury, disease, or infection, a transplant may restore vision, reduce pain, or improve the appearance of the affected eye.
Why Would Someone Need a Cornea Transplant?
A cornea transplant is necessary when the cornea becomes damaged or diseased, impairing vision or causing discomfort. Common reasons include:
- Keratoconus, a condition where the cornea thins and bulges outward.
- Corneal scarring caused by infections like herpes simplex or injuries.
- Fuchs' dystrophy, a genetic disorder that causes corneal swelling and vision loss.
- Corneal ulcers from severe infections that damage tissue.
- Complications from previous eye surgeries.
- Chemical or physical injuries that affect corneal clarity or structure.
In these cases, a transplant can restore vision, relieve pain, or improve the appearance of the eye.
How Does a Cornea Transplant Restore Vision?
A cornea transplant restores vision by replacing damaged or diseased corneal tissue with healthy donor tissue, improving the eye's ability to focus light properly. The cornea bends and directs light onto the retina at the back of the eye. When it becomes cloudy, scarred, or misshapen, this process is disrupted, leading to blurry or distorted vision.
By transplanting clear and healthy tissue, the cornea regains its smooth surface and proper shape, allowing light to pass through and focus correctly. This enhances visual clarity and can significantly improve overall vision quality.
Types of Corneal Transplantation: Full vs. Partial Thickness
Corneal transplants are categorized into full-thickness and partial-thickness procedures based on the extent of tissue replaced.
- Full-Thickness Transplant (Penetrating Keratoplasty)
This procedure replaces all layers of the cornea. It is commonly performed for severe corneal damage involving both the outer and inner layers. The surgeon removes the damaged tissue and sutures a circular section of donor cornea into place. - Partial-Thickness Transplants
These techniques involve replacing only specific layers of the cornea, preserving healthy tissue:- Deep Anterior Lamellar Keratoplasty (DALK) – Replaces the outer and middle layers while keeping the inner endothelial layer intact. Used for conditions like keratoconus or superficial scars.
- Endothelial Keratoplasty (EK) – Targets the innermost endothelial layer. Types include:
- Descemet's Stripping Endothelial Keratoplasty (DSEK/DSAEK) – Replaces the endothelial layer and Descemet's membrane.
- Descemet's Membrane Endothelial Keratoplasty (DMEK) – Replaces only the endothelial layer and is the most precise option, offering faster recovery.
The choice between full- or partial-thickness transplantation depends on the type and extent of corneal damage.
What is a Full-Thickness Cornea Transplant?
A full-thickness cornea transplant, known as penetrating keratoplasty (PK), replaces all layers of the cornea with healthy donor tissue. It is recommended for severe corneal damage or scarring affecting both outer and inner layers.
During surgery, the surgeon removes a circular section of the damaged cornea and sutures a matching section of donor tissue in its place. Recovery may take several months while sutures stabilize the graft.
What is a Partial-Thickness Transplant?
A partial-thickness cornea transplant replaces only the affected layers of the cornea while preserving healthy tissue, resulting in quicker recovery and fewer complications.
- Deep Anterior Lamellar Keratoplasty (DALK) – Replaces the outer and middle layers, leaving the inner endothelial layer intact. Suitable for keratoconus or superficial scarring.
- Endothelial Keratoplasty (EK) – Targets the innermost endothelial layer and Descemet's membrane. Variants include:
- Descemet's Stripping Endothelial Keratoplasty (DSEK/DSAEK) – Replaces the endothelial layer and part of the stroma.
- Descemet's Membrane Endothelial Keratoplasty (DMEK) – Replaces only the endothelial layer for a more precise repair and faster recovery.
The Cornea Transplant Procedure: What to Expect
The cornea transplant procedure involves several steps, from preparation to recovery.
1. Before the Procedure
- A thorough eye examination to assess corneal damage.
- Pre-operative tests to confirm suitability.
- Selection of a donor cornea from a tissue bank.
2. During the Procedure
- Performed under local or general anesthesia.
- For full-thickness transplants, the surgeon removes the damaged cornea and stitches donor tissue in place.
- For partial-thickness transplants, only affected layers are replaced while preserving healthy tissue.
3. After the Procedure
- An eye shield protects the eye.
- Medicated eye drops prevent infection and rejection.
- Follow-up appointments monitor healing and graft function.
Full-thickness transplants may take months to heal, while partial-thickness procedures often heal faster.
How is Transplant Surgery Carried Out?
Cornea transplant surgery is performed in a sterile environment and lasts one to two hours.
- Anesthesia
- Local anesthesia numbs the eye; sedation keeps you relaxed.
- General anesthesia may be used in children or complex cases.
- Preparation
- A trephine removes the damaged corneal section.
- The donor cornea is prepared to match size and shape.
- Graft Placement
- Full-thickness: donor tissue is stitched in place with fine sutures.
- Partial-thickness: only affected layers are replaced (e.g., DALK, DMEK, DSEK).
- Closure
- Alignment is checked and secured.
- A protective shield is placed over the eye.
Recovery After Corneal Transplant: Tips and Timeline
Recovery time varies by procedure type. Full-thickness transplants heal more slowly than partial-thickness procedures.
Timeline
- First Week – Discomfort, blurred vision, and light sensitivity are common; follow-up visits are critical.
- 1-3 Months – Vision gradually improves but may fluctuate; sutures remain in place for full-thickness grafts.
- 6-12 Months – Full-thickness grafts fully stabilize as sutures are removed; partial-thickness grafts often heal within 3-6 months.
Tips for Recovery
- Use prescribed antibiotic and anti-rejection eye drops as directed.
- Avoid rubbing or pressing on your eye.
- Wear an eye shield while sleeping and avoid strenuous activities.
- Protect your eye from dust, water, and sunlight with protective eyewear.
- Attend all follow-up visits to monitor healing and graft success.
Immediate Post-Surgery Care for Your Cornea
Protect the Eye
- An eye shield or patch is placed immediately after surgery.
- Wear the shield while sleeping to prevent accidental rubbing.
Use Prescribed Medications
- Antibiotic and anti-inflammatory eye drops prevent infection and control swelling.
- Immunosuppressive drops reduce graft-rejection risk; follow the schedule strictly.
Limit Activities
- Avoid strenuous activity, bending over, or heavy lifting to keep eye pressure stable.
- Rest and limit screen time until cleared by your doctor.
Attend Follow-Up Appointments
- Regular visits allow early detection of complications and medication adjustments.
Long-Term Recovery and Success Rates
Full-thickness transplants may require a year for complete healing, while partial-thickness procedures can heal within 3-6 months.
Key Aspects of Long-Term Recovery
- Regular follow-ups to monitor graft integration and suture removal.
- Continued use of eye drops to prevent rejection or inflammation.
- Vision adjustment with glasses or contact lenses as needed.
- Protection from trauma and management of underlying conditions like dry eye.
Success Rates
Corneal transplants have high success rates (85-95%).
- Full-Thickness Transplants – Effective for severe scarring or advanced keratoconus; longer recovery.
- Partial-Thickness Transplants – Slightly higher success due to lower rejection risk and quicker recovery (especially DMEK).
Potential Complications and How to Manage Them
Potential Complications
- Graft Rejection
- Symptoms: redness, pain, light sensitivity, vision changes.
- Management: corticosteroid eye drops or oral medication.
- Infection
- Symptoms: eye redness, discharge, worsening pain.
- Management: antibiotic or antifungal drops.
- Increased Eye Pressure (Glaucoma)
- Symptoms: headache, halos, blurred vision.
- Management: medication or surgery to lower pressure.
- Astigmatism or Vision Issues
- Causes: irregular healing or suture tension.
- Management: corrective lenses, suture adjustment, or further surgery.
- Graft Failure
- Symptoms: persistent clouding of the graft.
- Management: repeat transplant if needed.
Prevention and Monitoring
- Attend follow-up appointments regularly.
- Use prescribed medications as directed.
- Avoid rubbing or injuring the eye.
- Report unusual symptoms to your doctor immediately.
How Much Does a Cornea Transplant Cost?
The cost of a corneal transplant in Turkey ranges from $10,000 to $15,000 per eye, depending on procedure type, clinic, and surgeon. Prices are up to 70% lower than in many other countries, making Turkey an attractive option for medical tourism. Always research and compare clinics to ensure they meet international safety and quality standards.
