What is a corneal transplant?

A corneal transplant, also known as keratoplasty, is used for all corneal diseases that reduce visual acuity. The operation involves replacing the damaged tissue with a donor cornea. It is performed under general or local anesthesia.

Is corneal transplant surgery painful?

The corneal transplant itself is not a painful operation.

It can be performed either under local anesthesia, with a painless peribulbar injection (i.e., near the eye), or under general anesthesia. The choice of anesthesia is made by assessing the patient's condition and preferences and consulting with the anesthesiologist and the surgeon who will perform the operation.

In the first few days after the operation, there is often some discomfort in the eye, often described as a "gritty sensation", which tends to disappear within a few weeks.

Pain is rare in the first few days after the operation and may be due to various causes, including increased intraocular pressure. In these cases, the best way to prevent a serious complication is to contact the treating ophthalmologist as soon as possible.

How many days after a corneal transplant can I resume a normal life?

In the weeks immediately following the transplant, it is necessary to avoid all actions that could cause an increase in thoracic or abdominal pressure and, consequently, ocular pressure (e.g., lifting weights, strenuous physical exertion).

Contact sports (e.g., martial arts) or sports where the risk of eye trauma is high (e.g., tennis, squash) are not recommended until you are sure the injury is completely healed (approximately 18-24 months) and never without protection (e.g., polycarbonate glasses).

It is also advisable to avoid swimming in a pool during the first few months due to the irritation caused by disinfectants and the risk of contracting potentially very serious infections.

What are the risks of rejection of a corneal transplant?

The rejection rate varies depending on the pathology that necessitated the transplant. The risk increases, for example, in the case of corneal neovascularization, but this generally does not concern patients with keratoconus.

The rejection rate can reach 30%, but it should be noted that most of these cases are resolved with cortisone eye drops only.

Since it is essential that treatment is put in place quickly, any change in the course of treatment, such as redness, tearing, decreased vision, or secretion, should be reported immediately.

How long does a corneal transplant last on average?

There is documented decrease in the number of endothelial cells, which are the cells responsible for maintaining the transparency of the cornea, in both normal and transplanted corneas.

Theoretically, any transplanted cornea retains its transparency for at least 25 years, but there are cases of corneas transplanted 40 years ago that are still perfectly transparent.

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Almost a month and a half after the transplant, my vision is still blurry: is this normal?

It is quite normal that a month after a corneal transplant, your vision is still blurry. The transplanted cornea needs a few months to achieve perfect transparency and relaxation of the often present stromal folds.

Other factors besides corneal transparency can delay vision recovery, such as postoperative astigmatism and re-epithelialization of the ocular surface. All these elements should be discussed with your ophthalmologist.

Generally, visual function should already reach a reasonable level 6 months after the operation, then gradually increase.

What is scar revision?

A percentage of patients who have undergone a corneal transplant may require "adjustment of suture(s)" to reduce astigmatism.

This is a refinement of the operation aimed at achieving rapid improvement in visual function. The procedure can be performed under anesthesia with eye drops or by injecting an anesthetic around the eye.

The procedure is quick and generally painless.

Under what conditions is transplantation necessary?

In the case of keratoconus, the cornea is transparent, but the wear and tear it undergoes leads to myopia and irregular astigmatism. These two pathologies can only be partially corrected by glasses and are generally better corrected by a contact lens.

The contact lens is capable of providing excellent visual quality which is useful for many patients and for a long time. Certainly, the lens is not tolerated by everyone and sometimes becomes poorly tolerated over time.

It is clear that the role of transplantation surgery in keratoconus still depends on the tolerability of the lens. As the latter can offer excellent visual quality in the early stages of keratoconus, surgery is not the first choice of correction in these cases.

However, there are cases where the lens is not tolerated and glasses do not allow adequate correction. In this case, transplantation can offer a chance of improvement.

In particular, if the patient's corrected visual function with glasses is less than 4-5/10, transplantation is likely to offer a better visual outcome with adequate correction of glasses after the operation.

It should be borne in mind that the vast majority of post-transplant patients need glasses correction to achieve the best possible visual function.

Finally, corneal transplantation should never be understood by the patient with keratoconus as a means of "removing" their glasses, but as a means of obtaining better visual function, which will most likely require wearing glasses.