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The cornea is a dime-sized piece of tissue at the front of the eye. A normal cornea is clear and spherical in shape. The spherical shape allows light to pass through the lens and focus on the retina, forming an image which is then transmitted via the optic nerve to the brain. Some corneas have an irregular shape, and the irregular shape prevents light from being focused correctly on the retina. Often glasses or contact lenses can correct the problem; however, sometimes the problem is severe enough that a cornea transplant may be recommended.
Other factors also contribute to the need for a transplant. Some corneas are damaged by infection, injury, trauma or other eye conditions. Damage may cause the cornea to become cloudy. The cloudiness prevents light from reaching the retina, resulting in a distorted image. (Johnson and Deitch) In some cases, the clouding is so severe that the person is blind. (Eye Bank Association of America)
A cornea transplant, also known as a corneal graft or penetrating keratoplasty, is the procedure in which the damaged portion of a person's cornea is removed and replaced with a healthy portion of cornea from a donor eye. Donor corneas are obtained from the eyes of people who have died. It is not necessary for the donor to match the tissue type of the recipient as in other transplants. The donor cornea should be free of disease. Matching the ages of donor and recipient may help to prevent rejection. (Reynolds)
Most cornea transplants are performed in order to relieve loss of vision which is the result of damage to the cornea. Some transplants are performed in order to provide relief from pain. (Reynolds)
Many doctors are unwilling to operate on blind eyes because of the lack of visual benefits. Relief of pain in a blind eye may be reason enough for some people to opt for a transplantat if they desire to keep the eye relatively healthy.
Some doctors are also hesitant to operate on the eyes of people with very low vision, feeling that the risk of damage to the eye from complications is greater than the chance for significant measurable benefits. Cornea damage can significantly affect people with low vision, whose visual functioning is dependent on receiving the maximum amount of light possible in order to make sense of an already distorted image. Furthermore, changes in visual functioning may be significant to the person with low vision without being measurable in the ophthalmologist's office. Lighting in the office tends to be poor, and standard measuring instruments do not account for the many ways in which a person who is unable to read or interpret pictures may use his/her vision. If you have low vision and are considering a transplant, talking with your doctor about your individual situation is crucial. Getting a second opinion may help you to feel more comfortable in making decisions about whether or not to have a transplant.
Some discomfort after surgery is considered normal. The eye will be swollen and irritated for the first couple of weeks, and some people experience an occasional scratchy feeling or sharp pain when moving the eye. A dull ache may indicate a need for a change in medication or may be an early sign of rejection. Most pain can be lessened with Tylenol or its generic forms. Aspirin products are not recommended. If pain persists over a period of six to twelve hours, you should contact your doctor.
For several months after the surgery, protecting the eye is necessary at all times. During the day, this can be accomplished by wearing glasses. At night, a special shield is worn while sleeping.
Most people do not require an eye patch under the shield; however, if you have nystagmus, the gauze patch may help to keep the eye from moving and thus relieve some physical discomfort. You should not sleep in a way that places pressure on the eye.
After surgery, you will be prescribed medications appropriate to your unique situation. These may include antibiotics, steroids, and medications for glaucoma. Not all transplant patients take the same medications or the same dosages. It is important to stick to the routine prescribed by your own doctor and to discuss any changes thoroughly with him/her. Understanding the purpose of your medications may help you to be alert to signs that indicate a need for change. However, do not self-medicate or adjust the dosage of your medications without consulting your doctor.
Understanding your medications is also important because they may interact negatively with other medications you are taking or cause unpleasant side effects. Your ophthalmologist should be aware of any medications you are taking for other health problems. Although some doctors do not emphasize this fact, eye drops can cause side effects just as oral medications can because they drain through the tear duct into the rest of the body.
To lessen unpleasant side effects and maximize the benefits of eye drops to your eyes, apply a very small amount of pressure to your tear duct after administering the drop. The tear duct is a tiny structure in the corner of your eye near your nose.
When administering several eye drops in succession, the most benefit is gained by waiting three to five minutes between drops. This time allows the eye to absorb the medication, "making room" for another drop.
Your vision will be poor for some time after the surgery. During the first few weeks, the cornea will be less clear and still irritated. As it heals, you will experience visual improvement. Your vision may fluctuate from time to time; however, significant worsening of the vision should be reported to your doctor.
Because the new cornea may be a different shape from the old cornea, your glasses prescription may change. You may also find that your prescription changes more than once as your eye heals. Everyone's healing process is unique, and you should avoid comparing your outcomes with those of other patients.
Many people are able to return to doing light housework or officework shortly after surgery. To some extent, this depends on the visual functioning required for the task. Doctors advise against lifting heavy objects, doing strenuous exercise, etc., for several weeks following the surgery.
If you experience much physical discomfort after surgery, you may find it helpful to rest often. This may be particularly true if you have nystagmus. The medications you take to prevent rejection of the transplant weaken the immune system, and you may find that rest is more necessary than it normally would be. It is important to respect your own need for rest. Although a cornea transplant is not considered major surgery, it can affect a person in many ways, not the least of which is weakening resistance to illness in general.
Your doctor may give you different instructions than those provided in this article. Some doctors are conservative regarding after care and expectations during the healing period; others are more confident in allowing patients to be more active following surgery. This article was written with the needs of sensitive patients in mind. Erring on the side of caution is always best.
The rejection rate for cornea transplants is quite low; however, the health of a particular person's eyes may place that person at greater risk for rejection. Grafts may be repeated. If you are considering having a repeat graft, keep in mind that the risk of rejection increases with each graft. A person who has rejected more than one cornea will probably continue to reject them. At some point it becomes necessary to choose to adjust to vision loss and to grieve and learn alternative techniques for living with it.
Eye Bank Association of America. Basic Information About Cornea Transplants.
Johnson, S.; and Deitch, R. Understanding Corneal Graft Surgery. Patient information sheet.
Reynolds, J. Cornea Transplants.
This document is copyright 2003 by Sarah J. Blake. For permission to reprint, please email Sarah at sarah@growingstrong.org.
Sarah J. Blake is a person with a visual impairment who has also studied blindness and eye conditions. She is not an eye care professional, and information on this site is not a substitute for face-to-face consultation with an eye care professional. This site is designed solely to assist patients and doctors in building cooperative relationships.
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