Corneal transplant
When the cornea’s surface is cloudy or curved, it is difficult for light to enter the eye. In this case, the image of visible objects on the retina is inevitably distorted, and visual acuity decreases to complete blindness. Often the best solution to corneal problems is a corneal transplant.
During the operation, the surgeon removes the damaged area of corneal tissue and replaces it with a comparable scope of healthy corneal tissue from the donor’s eye.
Corneal transplantation is very effective and is performed annually in tens of thousands of patients worldwide. According to official statistics, this is the most common organ transplant operation.
Iran has excellent potential for treating eye disorders, in addition to cosmetic procedures like rhinoplasty that place it among the top in the world. Iranian clinics and medical practitioners are highly advanced and skilled and provide affordable treatments to patients worldwide and in the region. Experienced doctors in advanced clinics perform corneal transplantation in Iran.
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Corneal transplantation is performed to:
- Rebuild corneal integrity and restore vision (for example, with corneal perforation)
- Relief of the pain refractory to conventional therapy (for example, foreign body sensation due to recurrent blister rupture in bullous keratopathy)
- Treatment of diseases that have become resistant to treatment (for example, severe fungal corneal ulcer)
- Improve the optical properties of the cornea and vision (for example, replacing a cornea that has healed after a corneal ulcer;) clouded (Fuchs’ dystrophy or edema after cataract surgery); cloudy cornea due to deposits of opaque abnormal stromal proteins (for example, hereditary corneal stromal dystrophy); with irregular astigmatism, with keratoconus.
Indicators
The most common indications that you might need a corneal transplant are:
- Bullous keratopathy
- keratoconus
- Retransplantation of tissues
- Keratitis or post-keratitis (viral, bacterial, fungal infection or perforation due to Acanthamoeba)
- Stromal corneal dystrophies
Before the operation
If the patient has eye pathologies that can interfere with the successful implementation of keratoplasty, it is necessary to pre-treat them. Then the patient undergoes a detailed medical examination to identify contraindications to the operation. When collecting an anamnesis, the doctor is always interested in the drugs and the medication the patient usually takes. Some may have to be temporarily canceled or significantly reduced in dosage to prevent bleeding and other surgical complications.
A few days before a planned corneal transplant, the patient begins to instill drops with an antibacterial effect into the affected eye. On the eve of the intervention, the surgeon recommends that the patient refrains from eating and drinking for a specific time to endure anesthesia better. Usually, on the night before surgery, the last meal should be consumed before midnight, and on the morning of the operation, you are allowed to drink no more than ½ glass of water or tea. Corneal transplant surgery in Iran is performed by experienced nursing and medical staff, and they inform patients about the details of the surgery.
Methodology
Usually, tissue selection is not carried out. Cadaveric material may be used if there is no suspicion of transmissible infection. Corneal transplantation can be performed using general or local anesthesia with intravenous sedation.
Topical antibiotics are used after surgery for several weeks, and topical glucocorticoids for several months. The patient wears an eye patch, goggles, and sunglasses to protect the eye from accidental injury after transplantation.
If the entire thickness of the cornea was involved in the operation (penetrating keratoplasty), maximum visual acuity may take up to 18 months due to refractive changes after suture removal, wound healing, and correction of corneal astigmatism.
In diseases where the corneal stroma is clean, has a smooth stromal surface with normal curvature, and only the corneal endothelium does not function sufficiently (for example, in Fuchs’ dystrophy, bullous keratopathy because of cataract surgery), only the corneal endothelium is suitable for transplantation. Corneal endothelial transplantation uses two methods: Endothelial keratoplasty with Descemet’s membrane removal and the latest technique – endothelial keratoplasty with Descemet’s membrane transplantation.
Eye surgery in Iran has the most advanced technology among middle eastern countries. The diagnosis and consultation provided by Iranian physicians are reliable, and they can determine the correct surgery method.
For more information, read:
Cleopatra eye surgery in Iran 2022
The course of the corneal transplant operation
The patient lies on the operating table and is placed on a drip for intravenous infusion to prevent involuntary blinking, the surgeon uses a unique eyelid speculum. By the surgeon’s decision, local or general anesthesia is done.
Choosing the anesthesia method during corneal transplantation is mainly influenced by the following factors:
- Patient’s age
- The general health state of the patient
- The scope of the proposed intervention, etc.
In any case, both local anesthesia and general anesthesia guarantee that the whole procedure is painless.
Since the operation of transplantation of the cornea of the eye requires extraordinary precision during surgical manipulations, all the surgeon’s actions are carried out using an operating microscope.
In the first stage of the operation, the surgeon determines the of the diameter of the corneal tissue that is to be removed. Then, using a special trephine and other surgical instruments, the affected part of the cornea is cut in the form of a circle. An appropriately sized fragment of the donor’s cornea replaces the affected part. At the last stage of the operation, the donor tissue is sutured to the remaining peripheral part of the patient’s cornea using a very thin synthetic suture.
The operation is completed by the surgerevising the sutured cornea’s uniformity. He checks the shape of the newly created corneal lens for possible irregularities with a particular instrument – a keratoscope, which is designed to evaluate the corneal surface. Based on the revision results, the surgeon may decide to change the degree of tension of the sutures to align the shape of the cornea. At the end of the operation, the patient is given an injection of dexamethasone under the conjunctiva to relieve inflammation in the surgical wound quickly.
Postoperative period
After the corneal transplant operation, the operated eye is covered with a soft (gauze) sterile bandage, which is recommended not to be removed for 4-5 weeks. The patient receives detailed recommendations from the attending physician before being discharged from the hospital.
In the postoperative period, the patient is advised to limit touching the operated eye and eliminate external pressure. To relieve possible pain and inflammation and accelerate the healing of tissues and prevent rejection of the donor cornea, the surgeon prescribes several drugs – eye drops, gels, or ointments. These drugs must be used every day, with the frequency and duration recommended by the attending physician. In most cases, drops and ointments are prescribed for no more than 2 months.
Since a scar forms for a long time on an avascular cornea, the risk of divergence of the applied sutures will persist for many months. Because of this circumstance, the eye requires increased attention and special care. Trauma and heavy physical activity should be excluded entirely. After corneal transplantation, the sutures are removed after 8-12 months.
Possible complications and risks of corneal transplantation
Although most corneal transplants are successful, as with any surgical procedure, there is still a certain amount of risk. Experts refer to such threats as the risk of bleeding, infection, anesthesia complications, and rupture of sutures. Since a large area of the eyeball is exposed during the operation, there is a risk of postoperative leakage of eye fluid to the outside. Abnormal eye discharge or increase in intraocular pressure, the development of retinal detachment, cataracts, and glaucoma are not excluded. However, in practice, such problems rarely occur.
The most common complication of corneal transplantation is a rejection of a donor graft as a response of the patient’s immune system to the presence of foreign tissue. Such a complication is manifested by intense, persistent hyperemia of the eye and clouding of the transplanted cornea. After current keratoplasty operations, this complication develops in approximately 20% of cases. Most of them are removed with medications in the early stages.
In general, at least 90% of corneal transplants are successful. Most patients notice a significant improvement in vision after surgery, although myopia and astigmatism often develop. In the future, this requires spectacle correction or corrective laser surgery to achieve maximum visual acuity in the long run. As a rule, after a cornea transplant, vision restoration occurs gradually over several months.
For the success of the operation, the quality of the donor material, the technical equipment of the operating room, and the professionalism of the doctors are of great importance. Iran performs more than 6,000 corneal surgeries a year. Transplantation of the cornea is done in parallel with the most advanced countries. Among this part of the world’s best surgeons and eye care professionals are those from Iran. Their procedures and standards use minimal or no surgical incisions, making them one of the most advanced. For any consultation, don’t hesitate to call CarefulTrip.
For more information, read:
Eyes on Perfection: Advancements in Eye Surgery and Vision Correction