PORT ELIZABETH OPHTHALMOLOGIST’S

CORNEAL TRANSPLANT SURGERY

You have been diagnosed with a corneal problem that requires corneal transplant surgery. Corneal transplant surgery involves removing the central diseased portion of your own cornea (either full thickness or partial thickness) and replacing it with a donor corneal graft (Full-thickness or partial thickness).

The procedure needs to be discussed fully with your ophthalmologist to ensure you understand the mechanics of how the surgery is performed. This operation is statistically very successful at recovering vision. Depending on the nature of the corneal problem you have, there are, as with any operation, potential complications and side-effects that could arise during and after surgery. These are usually very uncommon and most are managed with good outcomes. As part of a well-informed process, it is important that you understand these and ask your doctor any questions that remain unanswered.

Potential intra-operative complications include:

  • Bleeding into the anterior chamber
  • Lens injury which could progress to cataract later
  • Iris tears or defects
  • Supra-choroidal hemorrhage and potential loss of intraocular content and blindness (very rare – 5 / 1000000 incidence)

Potential postoperative complications:

  • Wound leak
    • This could potentially require another surgical procedure to re-suture a wound leak.
  • Astigmatism or refractive error
    • This could potentially require another surgical procedure or laser to improve the refraction of the eye.
    • It should be understood that selective corneal suture removal or adjustment is needed on many occasions after the surgery during the first few months post-operatively. These are done in the doctor’s rooms and is not a surgery by itself.
  • Glaucoma / Raised eye pressures
    • This is common, but usually easily treated with topical medication and rarely requires surgery to reduce eye pressures
  • Graft rejection
    • This occurs in 25% of cases
    • With modern management of rejection episodes, the graft can be rescued and the rejection reversed in more than 90% of rejection cases
    • Long term therapy is potentially needed to prevent graft rejections
    • Depending on your underlying corneal problem, the chance for graft rejection can be much higher – this should be well discussed with your doctor before deciding on corneal transplant surgery
    • Graft rejection can lead to permanent graft failure and vision loss and potentially require another corneal transplant later
    • Symptoms of graft rejection include new onset of light sensitivity, redness of the eye, pain or vision loss – these must be reported quickly to ensure early treatment
  • Graft Failure
    • Only high quality well prepared corneal grafts are used during the corneal transplantation. Very seldom the graft can remain swollen and never recover its clarity due to endothelial cell failure.
  • Ocular inflammation and bleeding
  • Cystoid macular / Retinal swelling
  • Endophthalmitis
    • Infection in the eye after surgery is very uncommon (less than 1/100 000)It is important to understand that corneal transplant cases need a significant amount of time to heal and the rehabilitation process takes between 9 months and a year, with complicated cases often taking 18 months to reach final healing stage.

It is thus imperative that you as patient understand the following points:

  • The rehabilitation process takes a number of months and regular visits is crucial to ensure a good outcome.
  • Potential complications such as graft rejection can be managed very successfully, IF you as patient remain pro-active in your management and report any new symptoms or problems promptly.
  • A corneal graft is costly and precious, with many patients desperately needing this to regain vision. It is thus crucial that you as the graft receiver appreciate this fact and ensure that you care for the graft in the best way possible with adherence to follow-up visits and medication use post-operatively.
  • Understand that for the first month or two the graft is still swollen and vision slowly recovers over this period. After this, the recovery to crisp vision might need numerous suture adjustments and or even procedures over the following months.
  • Alternative options to corneal transplant surgery can include contact lenses, corneal implants, evisceration and even no treatment. These should be carefully discussed with your doctor on a case by case manner until you are satisfied and comfortable to proceed with transplant surgery corneal donor tissue used during the transplant is difficult and costly to acquire, and all medical aid funding providers approach reimbursement differently. It is very important to ensure that you have received quotations and proof of authorization from your medical aid before agreeing to the surgery. Please ensure you are fully aware of potential out-of-pocket expenses which you might incur when you proceed with the surgery.