The cornea is a clear window at the front of the eye. It’s very important for the cornea to remain clear to maintain good vision. Disease, infection or injury can all affect the shape and clarity of the cornea, causing blurred vision. Conditions affecting the cornea include:
- keratoconus (bulging of the cornea)
- keratoglobus (thinning and rounding of the cornea)
- trauma to the eye
- swelling from Fuchs’ corneal dystrophy
- scarring caused by infection or inflammation
Glasses or hard contact lenses can often be used to help improve vision for patients with these conditions. In more severe cases, a cornea transplant may be necessary, such as when the condition is progressive, or can’t be managed with glasses or contacts.
Diagnosing corneal problems
Using a special light called a slit lamp, your doctor will examine your cornea. They may also use other diagnostic tools, such as topography (to study the shape of the cornea) or pachymetry (to measure corneal thickness). Once your doctor has completed a full examination, they will make a recommendation regarding your treatment.
Conditions such as keratoconus or pellucid marginal degeneration can be progressive. If left untreated they can cause vision loss, but with early detection and treatment patients with these diseases can maintain their sight.
Types of cornea transplants and recovery times
During a cornea transplant, the doctor will replace your damaged cornea with a donated one. How long it takes to recover from cornea transplant surgery will depend on the type of transplant you have. There are three types of cornea transplants.
Penetrating keratoplasty: A full thickness cornea transplant, penetrating keratoplasty is used when the whole cornea needs to be replaced. Recovery time is the longest, taking up to a year or longer for your vision to fully improve.
Deep anterior lamellar keratoplasty: A partial thickness cornea transplant, this procedure removes only the top layers of your cornea, leaving behind the endothelial layer. It is commonly used to treat keratoconus. Recovery time is shorter (around 4 months) and the risk of the new cornea being rejected is lower.
Descemet-stripping automated endothelial keratoplasty: A partial transplant since only the endothelial cells are replaced. Often used to treat Fuchs’ endothelial dystrophy or trauma-related corneal problems. Uses smaller incisions so vision recovery is faster (around 6 weeks).
Cornea transplant surgery process and recovery
Cornea transplant surgery normally takes about 35 minutes. It can be performed under local or general anaesthetic. You typically won’t need to stay hospital and will be able to return home the same day. The day after your surgery you’ll need to return to the clinic for a check up and you will need to use eye drops to help bring down any inflammation and prevent the chances of infection. Corneal transplant surgery patients may need to use these drops for the rest of their life.
It’s important to take good care of your eye after a cornea transplant to help reduce the risk of complications and ensure a good recovery. You’ll need to wear an eye patch for a day or two after the surgery, until the top layer of your cornea heals. For two weeks after the surgery you should avoid heavy lifting and stay out of dirty, dusty environments. You’ll also need to keep the area dry; showering is fine, but no swimming. Your doctor will let you know when it’s OK to return to driving.
Other cornea treatments
Your condition may not be severe enough to require a cornea transplant. The following procedures are often used to treat less severe corneal conditions.
Keraring implants: Transparent, semi-circular, plastic implants that are placed in your cornea help bring it back to its normal shape. They are often used to treat milder cases of keratoconus, pellucid marginal degeneration, or keratoglobus.
Collagen cross-linking: A procedure that stiffens the cornea and stops it from becoming more misshapen. Cross-linking is a very safe and effective treatment for stopping the progression of keratoconus, pellucid marginal degeneration or keratoglobus. Although not a cure, it often prevents patients from needing a cornea transplant.
At EyeSpecialists we can diagnose and treat your corneal problems from their earliest stages all the way through to advanced cases requiring a cornea transplant.