Frequently Asked Questions

What happens during corneal transplant surgery?

Corneal transplant surgery is a delicate procedure, requiring the use of an operating microscope. Most of these surgeries are done on an outpatient basis, with no hospitalization necessary, although some patients may need to be kept overnight. Patients generally receive either local or general anesthesia, depending on their age and health.

Only the central part of the donor cornea is used. The surgeon determines the size required for the surgery then, using a special surgical instrument, he removes only that portion of the donor cornea. A similar sized portion of the patient’s damaged cornea is removed and the donated healthy cornea is sutured in place.

The suture material used to stitch and hold the transplant is so fine–about one-third the thickness of a human hair–that it is difficult to see.

Surgery takes approximately one to two hours and patients are usually discharged three hours later. Office visits in the first year following surgery are frequent, but are later reduced to three-to-six month intervals. Topical eyedrops, used frequently in the beginning, are also gradually reduced.

By using a computerized corneal topographer and other diagnostic tools, physicians can determine the amount of astigmatism (curvature) caused by the stitches (sutures) following surgery. Removal of the sutures is usually done a year after the transplant. This amount of time may vary, with some surgeons removing one or two of the sutures earlier, and others removing them later. Generally, the better the vision, the longer the sutures are kept in place.

What is the prognosis after corneal transplant surgery?

The prognosis for good vision after a corneal transplant varies with the disease for which the transplant is performed. For example, keratoconus and corneal dystrophy patients can expect good vision, but for patients who have had chemical burns, the prognosis is poor.

Corneal transplant rejection, which is much less serious than kidney or heart transplant rejection, occurs in approximately 10 to 15 percent of patients and can be countered with topical cortisone drops. This is successful in most patients and vision results are good. However, if the medication is not successful, another corneal transplant can usually be done, although this in only occurs in 1 percent of patients.

What causes corneal dystrophies?

Corneal dystrophies tend to run in families and are considered genetic. Some dystrophies are associated with dominant genes. In this case, a “dominant” gene for a corneal dystrophy is needed from only one parent for a child to inherit the condition. “Recessive” genes require both parents to carry the gene for a corneal dystrophy for the child to inherit the condition.

What are the most common types of corneal dystrophies?

The three most common types of stromal corneal dystrophies are:

• Dominant Granular Dystrophy — This type of corneal dystrophy usually starts in the first decade and appears initially as small white dots in the center of the cornea. Or, they may appear as lines radiating from the center of the cornea. These dots or white lines will increase in size and number until they start appearing as dense opacities.
• Recessive Macular Dystrophy — Usually starting sometime in the first two decades, recessive macular dystrophy is first seen as a thin, superficial veil. However, over time the patient experiences increasing haziness in the central part of the cornea as well as increasing isolated opacities.
• Dominant Lattice Dystrophy — This type of dystrophy usually strikes between the ages of 5 and 20 although it has been seen in infants. On examination, the patient may appear to have a lattice of fine lines. By age 40, the center of the cornea may become irregular, with various opacities. Some patients may experience acute painful attacks that may cause early vision loss; others with this condition may have a relatively slow, less severe progression.

Other types of corneal dystrophies include: Anterior Basement Membrane Dystrophy, Fuchs’ Dystrophy, Meesmann’s Dystrophy and Reis-Bucklers’ Dystrophy.

If corneal dystrophies run in my family, should I see a genetics counselor before having children?

It is always helpful to consult with a genetics counselor when you or your partner’s family have a history of any type of inheritable illness. This will allow you to make informed decisions regarding the health of your family. For more information, speak to your primary care specialist.

How are donor corneas obtained?

A corneal transplant is the final step of an involved process requiring a timely coordination.

It begins with the death of a donor whose family must give permission to the eye bank for removal of the eyes, usually within six hours, but preferably as soon as possible after death. A wide network of eye banks exists so that corneas can be shipped to any part of the country and used within a few days.

Under the auspices of the eye bank, the eyes are removed under sterile conditions and transported by plane, bus, police car or private automobile to the Lions Eye Bank of Delaware Valley, located at Wills Eye. Upon arrival at Wills Eye, the eyes are examined by a trained technician or by a Cornea Service physician to determine their usefulness for corneal surgery.

Contrary to what many people believe, it is not necessary for the donor to have had perfect vision, but his or her cornea(s) can only be used for transplantation if they are healthy.

Once the donor eyes are deemed satisfactory, the corneas are removed and placed in a special storage solution where they can last up to seven days after the death of the donor. Previously, corneas only 48-hours old were best for transplants but more recent techniques have improved storage capabilities.

The patient is then called and arrangements are finalized for surgery. If the surgery is urgent, the operation may occur within hours, as well as on a weekend or during a holiday. The Wills Eye Operating Room staff and anesthesiologists are always prepared for corneal transplants.

Although most of the eyes received at Wills Eye are used for corneal transplants, those that are not (because of previous eye disease or other problems) are not wasted. They are used for research and for medical training. The other parts of the donated eye, such as the sclera (the white part of the eye) may also be used in other surgical procedures.

Unlike kidney and heart transplants, tissue rejection in corneal transplants is less common. Intensive research, new treatment methods and sophisticated surgical techniques, along with better preservation methods, have helped to increase the success of this operation.

The need for donor tissue is great, with thousands of people around the United States now waiting for corneal transplantation. But, with a greater awareness of this need, and a better understanding of corneal transplantation, Wills Eye, as well as other facilities, may be able to obtain the tissue needed to treat patients and altogether eliminate the waiting list.

To learn more about cornea donations, contact the administrative offices of the Lions Eye Bank of Delaware Valley at (800) 462-1011.