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Lancaster, PA 17602
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Home » Your Eye Health » Eye Conditions » Corneal Transplant

Corneal Transplant

A cornea transplant, also known as keratoplasty or a corneal graft, replaces damaged tissue on the clear front surface of the eye.

When disease or injury damages the cornea, eyesight is affected. Light that enters the eye becomes scattered, resulting in blurred or distorted vision. When the cornea is extremely scarred or damaged, a corneal transplant is needed to restore functional vision.

Keratoplasty is performed routinely and is regarded as the most successful of all tissue transplants. According to the National Keratoconus Foundation, over 40,000 cornea transplants are done annually in the United States.

In recent years, an innovative type of corneal transplant has gained popularity. Known as Descemet’s Stripping Endothelial Keratoplasty (DSEK), this new procedure removes a smaller and thinner portion of the cornea. In 2009, DSEK was declared by the American Academy of Ophthalmology as superior to the conventional surgery because it may provide better vision outcomes and more eye stability. It is also associated with less risk factors. However, when the majority of the cornea is damaged, a more comprehensive removal may still be necessary to facilitate a successful transplant.

Criteria for a Corneal Transplant

A multitude of reasons indicate candidacy for a corneal transplant. Possible reasons include:

  • Eye diseases, such as keratoconus
  • Complications from laser surgery, such as LASIK
  • Extreme inflammation on the cornea
  • Scarring as a result of infections, such as eye herpes or fungal keratitis
  • Thinning of the cornea and an irregular shaped cornea
  • Hereditary factors
  • Corneal failure due to previous surgical procedures
  • Chemical burns or injuries that damaged to the cornea

Cornea Transplant Procedure

Once a patient has been recommended and approved for a corneal transplant to restore vision, the patient’s name is added to a list at an eye bank. The United States has a very advanced eye bank system, and the general wait time for a donor eye is one to two weeks. The tissue of donor corneas is checked for clarity and screened meticulously for disease before it is released for transplant.

The actual surgery is generally performed as an outpatient procedure that does not require hospitalization. General or local anesthesia may be used, depending upon the patient’s preference, age and health condition. Local anesthesia is injected into the skin surrounding the eye, which relaxes the muscles that control movement and blinking. Eye drops numb the eye itself.

Once the anesthesia has taken effect, the surgeon inspects and measures the damaged corneal area in order to decide upon the size of the transplantation. Eyelids are held open during this time. The surgeon then removes a round, button-shaped piece of the corneal tissue and replaces it with a nearly identical sized button of donor tissue. The new, healthy tissue is sutured into place. The entire procedure takes approximately one to two hours.

Following the surgery, a plastic shield must be worn over the eye in order to protect it against any inadvertent bumps or rubbing.

Rejection of the Corneal Graft

Although the vast majority of cornea transplants are successful, sometimes the new tissue is rejected. Warning signs of rejection include:

  • Extreme sensitivity to light
  • Redness
  • Pain
  • Decreased vision

These symptoms may be experienced as soon as one month after the surgery, or as delayed as five years later. Medications can be prescribed to reverse the rejection process. If the corneal graft fails completely, the transplant can be repeated and the outcome is generally positive. Yet the total rejection rates do increase with the total number of corneal transplants.

Recovery and Healing

It can take up to a year or longer to heal completely from a corneal transplant. At the beginning, vision is blurry and the transplant site is often swollen and thicker than the rest of the cornea. As vision returns, patients are able to return to normal daily tasks and most people can return to work within three to seven days after surgery. However, heavy lifting and exercise must be avoided for the first few weeks.

To help the body accept the corneal graft, steroid eye drops must be applied for several months. A pair of eyeglasses or a protective shield must also be worn for eye safety. Depending upon the health of the eye and the healing rate, stitches may be removed at any time from three months to more than a year later. Astigmatism often occurs as a result of an irregular corneal surface, and adjustments may be made to the sutures around the new cornea in an effort to reduce this problem.

Vision after a Cornea Transplant

Vision improvement after a cornea transplant is a process that can last up to one year later. Eyeglasses or contact lenses must be worn immediately after the surgery, since the curvature of the corneal transplant will not precisely match the natural corneal curve.

When healing is complete and stitches are removed, laser surgery may be indicated to correct vision. LASIK or PRK are both procedures that can help decrease dependence on eyeglasses or contacts. An irregular corneal surface may point to the need to wear rigid gas permeable (GP) contact lenses for vision correction.

Dear Patients,

We will be reopening our office Monday, May 18, 2020, and would like to bring you up to date with the many very important physical and procedural changes we have made to our office to assure the highest level of health and safety for our patients and staff during these very challenging times.

We have consulted with our county, state and federal officials, as well as the CDC and other healthcare professionals, to incorporate the recommended and required safety measures throughout our office.

We sincerely apologize for any inconvenience we may have caused by rescheduling or postponing your earlier appointments.

To assure the health and safety of our staff and patients, as well as minimize any exposure, we have instituted the following changes. Please read through this entire document and print a copy so you are familiar with them.

1. Any and ALL appointments and visits will need to be scheduled. This includes the pickup of eyeglasses or trial contact lenses, frame selection, eyeglass repairs, and eyeglass adjustments.

2. Contact lenses will be shipped to all patients at no charge

3. To maintain social distancing and minimize any possible exposure, we have spread out our patient schedule.

4. 24-48 hours before your appointment, one of our staff will be calling to remind you of your appointment and discuss your ocular and medical history. In addition, they will ask you standard COVID19 screening questions and answer any questions regarding your upcoming exam. This will take 5 – 10 minutes but this initial call is important to allow you ample time in our office.

Please look for and answer this call.

5. In order to save time and keep everyone on schedule, any and all medications you are taking should be listed in as much detail as possible on a separate piece of paper, emailed to our secure site: DROXENBERG@COMCAST.NET, or entered on the patient registration form on our website: WWW.DROXENBERG.COM. This needs to be completed prior to your appointment and should include all systemic medications (diabetes, hypertension, etc.) and ocular medications (eye drops, glaucoma medicine, etc.).

6. On the day of your appointment please plan to arrive 15 minutes early and call us at (717) 394-3798 when you arrive. We will return your call when you will be allowed to enter. Entry will be through the front door only unless previously discussed with our staff. Only the person with the appointment will be allowed in the office with the exception of minor children who have the appointment. NOTE: Family members and/or friends will need to wait outside.

7. We will be taking your temperature in the vestibule and anyone with a temperature of 100 degrees or higher or who is sick will be rescheduled. If you feel ill, please reschedule your appointment.

8. All staff will have their temperatures checked 2 times daily for your safety.

9. All staff will wear a facemask while in the office. In addition, all patients must wear a facemask while in the office as mandated by Governor Wolf for all PA businesses. If you do not wear a facemask, one will be provided to you.

10. There are hand sanitizing stations strategically placed throughout the office. Please use them.

11. All frames will be disinfected before and after being handled by patients and staff. Frames will not be returned to the frame display until they are appropriately disinfected.

12. All exam room equipment will be cleaned and disinfected before and after each use according to the CDC guidelines.

13. Cleaning and disinfection of our office have always been a priority and this will continue in earnest.

14. Preferred payment is by credit card or checks at the time of services but cash will be accepted.

15. We have installed a plexiglass barrier on our front desk to comply with the CDC and state guidance.

16. Reception area chairs have been separated to maintain social distancing.

17. Patients who are physically disabled will be allowed entry through the rear door, with prior approval, following a temperature check and COVID19 screening. All other patients must enter through the front door and screening vestibule.

18. Above all else, your safety and health are our top priorities. We take this responsibility very seriously and have implemented these changes in procedures to achieve this.

Dr. Oxenberg has been providing eye care to you and your family since 1990 and expects to continue for many years to come.

If you have any questions and /or concerns, please feel free to email our office at droxenberg@comcast.net or call (717) 394-3798.

We look forward to seeing you all again!

Sincerely,

Dr. Larry Oxenberg