Corneal transplantation surgery (corneal transplantation) is a surgery to replace the patient’s cloudy or diseased cornea with a donor cornea. Corneal transplantation is considered a type of organ transplant surgery, with a success rate of 70-95% (Le R, et al., 2017), depending on the patient’s condition and disease.
Psychological Impact
Since corneal transplantation is a major eye surgery, it may cause psychological effects on the patient, such as anxiety, stress, depression, anger, or disappointment. These problems may occur but are uncommon. Doctors will assess the patient’s physical and mental readiness before considering the surgery.
Why is corneal transplantation necessary?
- To improve the patient’s vision, which is the main reason for the surgery
- To strengthen the cornea in cases where the patient has a thin or perforated cornea
- To control corneal infection in cases where the patient has an infection in the cornea
Complications from corneal transplantation surgery
In every surgery, ophthalmologists carefully evaluate the lesion and plan the treatment. However, complications may still occur, although rarely, such as:
- During surgery
Accidental injury to the innermost layer of the cornea, iris, lens, vitreous hemorrhage, and the most severe condition is bleeding under the retina - Early postoperative period
The surgical wound may leak, shallow anterior chamber, iris prolapse, abscess at the suture site, permanent corneal epithelial abnormalities, increased intraocular pressure, and dangerous eye infections that threaten vision - Late postoperative period
Astigmatism, late wound dehiscence, central visual axis edema, recurrence of the original disease in the donor cornea, and glaucoma - Faster than normal corneal clouding
From the first day after surgery, usually caused by abnormalities in the innermost layer of the donated cornea or surgical trauma - Late corneal clouding
Usually caused by the body’s rejection of the transplanted cornea, as the immune system recognizes the donor cornea as foreign and attempts to destroy it. This mostly occurs from 2 weeks to 1 year after surgery. Symptoms include decreased vision, red eyes, irritation, tearing, and light sensitivity. The main treatment is corticosteroid medication.
Travel recommendations before and after corneal transplantation surgery
Before surgery
- Patients should stay in Thailand for at least 2 weeks to 1 month throughout the treatment period (excluding the waiting time for the cornea)
- It is recommended to stay at a hotel near the hospital for convenience in traveling to the hospital before and after surgery
- Patients will undergo a physical examination before surgery, as the surgery requires general anesthesia and fasting before the examination
After the procedure
- Patients will be monitored for symptoms for at least 1-2 weeks before they can travel by plane, depending on postoperative condition and doctor’s discretion
Success rate of corneal transplantation surgery
Success depends on several factors, including
- The patient’s cornea, such as previous surgeries and corneal strength
- The patient’s health, such as whether existing chronic diseases are regularly treated
- Cooperation during surgery and self-care after surgery
- Other ocular complications, such as glaucoma, retinal diseases, uveitis, etc.
- Ophthalmologists specializing in cornea will evaluate and provide information about the treatment success after assessing the patient’s eye condition
Steps of corneal transplantation surgery
Corneal specialists will evaluate the patient before surgery and refer the patient for a physical examination with an internist to prepare for general anesthesia. The surgery takes about 1-2 hours. The ophthalmologist will remove the patient’s cornea, usually 7-8 millimeters in diameter. At the same time, the ophthalmologist will select a slightly larger donor cornea and implant it into the patient. The surgical wound will be circular around the cornea, sutured with fine stitches.
Other treatment options for the cornea
- Partial thickness corneal transplantation
This treatment involves removing only the front layer of the cornea with pathology instead of the full thickness of the cornea. The advantage of preserving the innermost layer of the cornea is reducing the chance of rejection caused by transplantation. However, partial thickness corneal transplantation is a more difficult procedure.
Suitable patients for partial thickness corneal transplantation
- Corneal damage from other eye surgeries, such as cataract surgery
- Irregular corneal curvature or keratoconus
- Corneal damage from genetic causes, such as abnormalities of the innermost corneal layer
- Corneal scarring after injury or infection
- Previous corneal transplant rejection
