Keratoconous - Corneal Transplant

Corneal Transplant is our final option in treating keratoconous. These transplants have a very high success rate (92-95% for patients aged 20-35). The replacement of the central part of the cornea with a donor transplant is called keratoplasty or corneal transplant. Depending on whether the full central cornea or just the part that has the problem it is divided into Penetrating Keratoplasty (PKP) and Lameral Keratoplasty.

A) Penetrating Keratoplasty

Is the most common procedure for advanced keratoconous. During this transplant the whole central segment of the cornea is tranplanted from a healthy donor. It is done using local anesthesia and lasts for ½ to 1 ½ hours depending on the difficulty of the situation. The new cornea is sutured in place using threads that are thinner than a human hair. After the procedure the patient can return home. The eye remains shut and the eye patch is removed by the surgeon in the next meeting. Eyesight is not improved instantly like in the laser corrective surgery but is gradual and takes a few months for the final result.

Β) Lameral Keratoplasty

When prossible we prefer this option from the penetrating Keratoplasty. In this option we usually remove the frontal part of the cornea while we leave the endothelium of the cornea untouched. The cornea is divided in two (75-95% deep) with specialized microsurgery techniques the surgeon removes the frontal part and replaces it with a healthy donors tranplant. This 'biological lens' is again sutured in place and like in penetrating keratoplasty the patient can return home the same day.

Keratoconous is a disease which – in most cases – affects the curvature and opaqueness of the cornea. A good cooperation of the optometrist and the surgeon leads to an improvement in the eyesight of the patient which can be maintained throughout his/her life.

What is the probability that the transplant will be rejected?
Transplants are rejected very rarely and for keratoconous the rejection percentage is under 5%. The reasons for this is that the transplant is sutured on avascular tissue. For this reason vefore the transplant we rarely taste for 'matching donors' and even the blood group of the donor is irrelevant. Post procedural treatment consists of eye drops that have to be taken every few hours in the first days. Usually the treatment stops after 3-4 months and very rarely we need to take some extra measures before or after the transplant.

Are there any other side effects apart from rejection?

Corneal transplant side effects are the same as those of any other eye operation (cataract) and they are infection, inflammation, bleeding, the increase of eye pressure etc. These are quite rare and in most cases treatable.

Apart from these though we must mention that there is a chance of development of post operational astigmatigm which is quite common for keratoconous. The experience that the surgeon has, the size of the transplant, the equipment used are very important but they do not ensure that the eyesight will be restored fully without glasses after the operation.

When does the patient return to normal lifestyle after the procedure?

The patient returns home on the same day and the eye patch is removed on the following day after the operation. Visual acuity is improved gradualy over the next few months and the patient does not need to stay in bed after the operation. Depending on the level of eyesight that the patient had before the procedure (which is usually very reduced) the patient can return to his daily duties by taking certain precautions (like protective glasses).

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