30 Jul 2019
Patient from Ghana underwent Cornea Transplantation in India
Introduction Hailing from a small village in Ghana, Gladys Appiah, a woman of 34 years… Read More
Cornea transplant surgery is also known as keratoplasty. It is a common surgery and has a good amount of success rate as well. Cornea transplant is required for people who have their corneal tissue damaged due to scarring or bruises. This affects the normal vision, which cannot be further corrected with the help of lens or medication. The cornea can swell thus resulting in distorted vision and it can grow painful, thus destroying the tissue gradually.
The following are some of the reasons why cornea replacement surgery may be required:
Cornea transplant surgery involves the replacement of the diseased cornea with a healthy cornea from a donor and it is performed commonly. However, there are some risks of rejection that would always be there. A corneal transplant is a surgery conducted to replace the cornea with a tissue retrieved from a donor. It is one of the most common types of transplants done. The cornea mainly comprises of five layers and it is not always necessary that all the layers are transplanted during the surgery.
In case of full thickness cornea transplant, all the 5 layers of the recipient are replaced with the healthy corneal layers of the donor. Lamellar cornea transplant includes only transplanting some of the layers of a donor’s cornea in the recipient patient’s corneal layers. The layers that are transplanted in this kind of surgery may include the deepest layer, which is known as the endothelium and this is generally known as the posterior lamellar cornea transplant. Some of the included procedures of this type of transplant include Descemet’s Stripping Automated
Endothelial Keratoplasty (DSAEK) or Descemet’s Membrane Endothelial Keratoplasty (DMEK). It may also have layers nearer to the surface included, which is referred as anterior lamellar cornea transplant. When only a portion of the cornea is diseased and not the entire cornea, then the lamellar transplants appears to be much more suitable compared to a full penetrating transplant.
Prior to the surgery, a medical examination along with routine laboratory tests are conducted to find out the blood cell count and to check for the fitness of the patient for the surgery. It is advised for the patient to stay away from aspirin for two weeks before the surgery. Antibiotic eye drops are administered to the patient a day before the surgery.
Deceased donors are considered for a cornea transplant and they must go through the formalities of eye donation a long time before the actual procedure is conducted. The patient may have to wait for a few days to weeks to find a donor with a suitable tissue for the transplant.
Before taking the cornea from the donor, it is checked for diseases such as hepatitis, AIDS, and a number of other ailments. Only a cornea that meets the suitability criteria for transplant is chosen for grafting.
Cornea transplant surgery is conducted on an outpatient basis, wherein the patient can leave the hospital on the same day of the surgery. In the pre-op or the waiting area, the patient is prepared for the surgery by giving medications, which would relax the patient.
A needle is attached to a tubing, which aids in delivering medications and fluids throughout the procedure to the vein of the patient. Electro leads are attached to the patient’s chest to have the performance of heart monitored at all stages. The above are some of the standard safety precautions.
Depending upon the condition of the patient, local or general anaesthesia may be administered before the surgery. Some of the determining factors can be age, length of the surgery, levels of anxiety of the patients, general health of the patient, and of course, the doctor’s choice. This should be discussed with the patient before the operation.
Once in the operating room, the patient’s eyelids are washed gently and carefully and then it is covered with plastic sterile drapes. Through a plastic tube, oxygen can be occasionally supplied somewhere close to the nose where the tube is placed. Most patients doze off during the procedure, while others may remain slightly conscious.
The instrument used to scrape off the part of the cornea is a circular cookie-like cutter instrument, which is called a trephine. It is employed to have the center of the diseased cornea removed. Next, a button-sized similar portion is cut from the cornea of the donor. With the help of nylon sutures, the tissue of the donor’s cornea is sewn in the recipient’s eye in the already cut section.
The sutures are employed in corneal transplant and they are composed of monofilament nylon and are very tiny, almost one-third the thickness of human hair. The patterns of suturing can be different, depending upon the choices of the surgeon and their training and also on the specific problem that is being addressed. In certain cases, 16 individual (interrupted) sutures can be used, while for others, continuous or running sutures can be used that closely resemble the hemstitch. A combination of both can be used and the results obtained are more or less similar.
With the conclusion of the surgery, a patch along with a shield is applied to the eye for protection. Now the patient is taken to the recovery room, wherein some of the parameters of the body are monitored and the patient is allowed to recover and get back to his or her senses before being discharged off.
The cornea has no blood supply, hence the healing of the procedure is slow. Sutures are kept for 3 to 12 months and if the vision is found to be really good, then they are kept in place. They do not cause any discomfort since they are buried but if they break, then their removal is required. At other times, the sutures can loosen. The removal of the sutures is a painless and simple procedure.
Immediately after a cornea transplant, the patients may experience pain, which can be relieved with medications such as Tylenol. The eye will remain patched until the healing of the epithelium is not completed. The surgeon checks immediately after the day of the surgery and advises whether it should be worn any longer or not.
Eye drops should be administered as prescribed and strenuous activities should be avoided for a few weeks. A pair of glass must be worn for a duration recommended by the surgeon. Watching the television does not cause any discomfort to the eyes. However, contact the surgeon if you experience discomfort in the eye or pain as soon as possible.
Q: How successful is a cornea transplant?
A: Nearly 89 percent of the patients with keratoconus are treated successfully, while 60 to 70 percent of the patients with scarring and 73 percent of the patients with Fuchs’ corneal dystrophy are treated successfully.
Q: What is the cost of cornea replacement surgery?
A: The cornea transplant cost varies from one country to the other. Additionally, it also depends on the hospital that you are planning to undergo treatment at. Some of the other factors that influence the corneal transplant cost include the experience of the surgeon, the type of corneal transplant, and the approach used for corneal replacement surgery.
Q: How safe is a cornea replacement?
A: Cornea transplant or replacement is a safe procedure. But it is still associated with a small risk of complications such as a problem with the stitches and the rejection of the graft used.
Q: Can you see immediately after a corneal transplant?
A: The improvement in eyesight takes place over a period of time. Some patients may take a few months before a stability in vision is experienced.
Q: Can corneal transplant cure blindness?
A: Corneal transplant is only helpful in the treatment of blindness and vision loss arising out of damage or injury to the cornea.
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