A corneal graft is a transplant operation, involving removal of the central part of the cornea (the clear front window of the eye) and its replacement with a cornea from a donor.
A corneal graft may be performed in isolation or together with another procedure, such as cataract surgery. It takes a long time to recover from a corneal graft operation we hope this information sheet will help you to understand what to expect. However, it is not possible to provide specific, tailored information in this way. Your surgeon will give you additional information based upon knowledge of your own case.
Most of the information in this document concerns a full thickness (penetrating) corneal graft. There is a section at the end giving information about partial thickness (lamellar) grafts.
Inner Layer Corneal Transplant
Full Thickness Corneal Transplant
The Normal Cornea
- Remain clear
- Focus light on the retina by having the correct amount of curvature
If the cornea is not clear it will block light coming into the eye. This may result from: scarring by infection or inflammation; swelling with fluid from inside the eye; inherited disorders; trauma; metabolic disorders, and other reasons. The vision may be compared to looking through a murky window.
If the curve of the cornea is not right, then light will be focused in front of the retina (short sighted), behind the retina (long sighted), or in multiple places (astigmatism). This results in blurred vision.
Adjustment of continuous sutures may be very helpful for some patients. Adjustment may be done in the clinic or in the operating theatre, depending upon circumstances. It enables the cornea to sit more snugly in place, allowing it to focus better.
The exact timing of suture removal varies greatly between patients and has to be decided on an individual basis. Removal of sutures too early after the operation could result in the graft coming apart and requiring re-suturing. Eventually, however, approximately 12 to 24 months after the operation, all your remaining sutures may be removed.
After a corneal graft, your eye is very vulnerable to blows and to the effects of severe straining (bending down, pushing or lifting). You should not take any more exercise than a brisk walk for the first month after the operation. You should avoid lifting heavy objects, and if you have to bend down, do so slowly from the knees, keeping your head up. Get help with hair washing, and do it with your head back, avoiding soap and shampoo in the eye. You should wear an eye shield at night until you are used to not sleeping on the side of the operated eye. It’s a good idea to wear glasses or sunglasses simply for protection, even if they don’t help the vision.
Above all, don’t poke or rub the eye!
If you do an office job, you can usually go back to work after about two weeks. But if your job is more strenuous, you will be advised to stay off work for at least a month, or in some cases even longer. If you drive, you can usually start again after your first check-up, provided that the vision in the other eye remains satisfactory. If you play sports, it is essential to wear eye protection at all times after a corneal graft. Eye protectors for racket sports are available in sports shops. If you swim you should wear goggles (primarily for protection from injury, not contact with water) and you should not dive in. If you play football there is a small risk of serious injury, particularly when heading the ball. Again you should consider eye protectors. You are strongly advised not to play major contact sports such as rugby, judo etc., at any time after a corneal graft, and not to recommence sports until you have been told that it is safe to do so. In the long term, a corneal graft is strong enough to stand the rigours of ordinary life, but an eye with a corneal graft is never as strong as a normal eye and may be split open by a severe blow such as a punch in the eye. Such an injury can cause blindness.
There are risks attached to any operation, involving the operation itself and the anaesthetic given in order to carry it out. These are some of the most important risks of corneal grafts.
These may happen from time to time but do not usually affect the result. They include brief periods of raised pressure or leaks of fluid between the stitches from within the eye. These generally settle within a few days of the operation. However, occasionally it is necessary to replace a stitch, or put in an extra one, if a leak doesn’t seal up on its own.
These are rare, but when they occur they can threaten sight or even possibly cause the loss of the eye. They include bleeding within the eye and infection entering the eye. They may require further operations if they occur.
Is a possible complication of any transplant – in other words, the recipient could possibly catch a disease from the donor. All corneal donors are tested for the viruses that cause hepatitis and AIDS. However, there is no test that will detect the germ that causes Creutzfeld-Jakob disease (CJD), and unknown viruses may also exist for which there is currently no test. The risk of catching such a disease is unknown, but likely to be small.
Is a major complication that can affect any transplant. It happens when your body detects that a piece of tissue from another person, and your immune system then tries to destroy it. About one in seven patients who have a corneal graft will have a rejection attack at some stage, although some patients are at a much greater risk than others. Rejection can start as soon as two weeks after a graft, but is commonest several months afterwards, and may occur years later. The quicker rejection is diagnosed, the better the chance of recovery. If your eye gets red, watery or gritty, and you lose some vision, then rejection may be the cause and you are advised to attend your eye casualty department immediately. If rejection is found, it is treated with very frequent, strong steroid drops, and occasionally with steroid tablets or drip feeds. Most corneal grafts do recover from their rejection attack, but a lot of patients will need to go on with the steroid drops for a long time afterwards, sometimes permanently. Patients who have a high risk of rejection may be given steroid tablets before and after surgery to try to reduce this risk.
For the purpose of surgery, we think of the cornea as being made up of 2 parts:
- The front = epithelium, Bowman’s and stroma;
- The back = Descemet’s and endothelium
If the cornea only has a problem in one part (e.g. a scar in the stroma), it may be possible to replace only that part of the cornea. This leaves normal, healthy tissue in place. While the general experience of a patient undergoing a lamellar graft will be similar to that of a patient having a penetrating graft, there are some slight differences.
The most common and most serious type of rejection occurs against the deepest layer of the cornea (the endothelium). If this is not replaced then rejection is much less likely to occur. This in turn means that less steroid drops are needed. Also, the eye retains some structural strength and may be a little less vulnerable to injury. Finally, it is possible that stitch removal may safely be done a little sooner after the operation. Back part replaced, front part left in place
If only the endothelium is not working properly, it may be possible to replace it through an opening at the side of the cornea. This means that sutures are less likely to be needed, there will be less astigmatism and refractive error, and the visual recovery will be faster Please note however that only a minority of patients needing corneal grafts are suitable for a lamellar operation. For the rest, a lamellar graft would be of no benefit.
As with any surgical procedure, there are risks of which you must be aware. Your doctor will explain these risks to you and ensure that you understand them completely. You will be given time to discuss all issues to your satisfaction.