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Corneal Transplant Program

2011 Cleveland Clinic corneal transplantation facts and figures

Corneal transplants at Cleveland Clinic were initiated in 1970. In 2011, Cole Eye Institute surgeons performed 208 corneal transplants, including penetrating keratoplasty, endothelial transplants, and deep anterior lamellar keratoplasty. Amniotic membrane grafts are used in some cases to facilitate healing of the corneal surface. Our staff also has experience dating to 2005 with implantation of the Boston Keratoprosthesis as a mode of restoring vision in patients with end-stage corneal disease or a history of multiple prior graft failures.

Cleveland Clinic ranks 7th in the nation for ophthalmology, according to the 2013-14 U.S. News & World Report's "America's Best Hospitals" rankings.

What is corneal transplantation?

Details are clear and colors are bright again for Chris Arth, a corneal transplant patient.

The cornea is the central part of the front of the eye through which we see. Normally, the cornea is smooth and clear. However, injury, disease or certain medical conditions can make it cloudy or difficult to see through. Sometimes this problem can be fixed by removing some or all of the cornea and replacing it with corneal tissue from an organ donor. This operation is called corneal transplantation.

About 46,000 corneal transplantations are performed in the United States every year, according to the Eye Bank Association of America.

Is it safe to receive donated corneal tissue?

Yes. The medical history of every organ donor is reviewed carefully, and blood tests are performed to check for infections prior to corneal transplantation. If there is any doubt about the safety of corneal transplantation, the donated tissues are used for medical research instead of being transplanted into a patient's eye.

    Each year, our physicians see more than 150,000 patients and perform more than 5,000 surgeries — volumes among the highest in the nation. Care is delivered, all in one convenient location, in a state-of-the-art building that demonstrates our commitment to putting patients first.

    We know that learning about the corneal transplantation process and how to care for your eye health may be overwhelming at first. But remember, you can learn a little each day.

    We understand that you are both excited and nervous about your transplant; these are normal reactions. Being prepared in advance by learning and understanding what to expect will help ease your fear of the unknown.

    Always discuss your questions and expectations about the transplantation with your healthcare providers.

    What happens in a corneal transplantation operation?

    Corneal transplantation can be done under general anesthesia; that is, with the patient “asleep.” Local anesthetic, in which the patient is awake but does not feel the procedure, also can be used.

    A portion of the cornea is removed using scissors and a special instrument called a trephine, which works something like a tiny circular cookie-cutter. This leaves an opening in the patient's cornea.

    A similarly sized trephine is used to cut a section from the donor cornea. This section of corneal tissue is placed into the opening in the patient's cornea and fastened with very small stitches.  Many patients qualify for a partial-thickness corneal transplant procedure called DSAEK (Descemet's stripping with automated endothelial keratoplasty) tailored to particular corneal disorders. This procedure can provide faster recovery with less visual distortion. 

    After surgery, it is important not to put any pressure on the eye. It is best not even to touch or rub anywhere near the eye, so the doctor might put a shield over it. Wearing glasses or sunglasses will also help protect the eye.

    Your doctor will prescribe eye drops to help the eye heal and prevent infection. It is necessary to keep using some of these medications for several months after a corneal transplant. Without these medications, the eye is much more likely to have problems with the new corneal tissue.

    How successful is corneal transplantation?

    The majority of the corneal transplantations done in patients with keratoconus, corneal scars and most types of corneal disease are successful. The operation is less successful in eyes with a corneal infection or severe injury such as a chemical burn.

    Why do people need a corneal transplantation?

    A doctor can recommend corneal transplantation only after a careful examination of the eye. The most common reasons for performing the operation are:

    • Injury to the eye — Sometimes an injury will damage the cornea so severely that it will not heal correctly. The cornea plays an important role in vision, so even a small injury to it can greatly reduce vision. The doctor might recommend a corneal transplant to improve vision or, in more serious injuries, a transplant might be the only way to close the wound in the eye.
    • Medical conditions — Some infections of the eye can cause damage to the cornea that will not heal. There are also certain medical conditions that make the cornea very thin or cloudy, or cause other problems that can only be treated by replacing the cornea.
    • Pseudophakic bullous keratopathy — Some people experience corneal swelling and clouding after cataract surgery. This is known as pseudophakic bullous keratopathy and is a common reason for corneal transplantation.
    • Keratoconus — Sometimes the cornea is thin and weak, and the normal pressure inside the eye makes the cornea bulge outward in a cone shape. This is called keratoconus, and it causes severe vision problems. If these problems are very troublesome, the doctor might recommend a corneal transplant. More information is available in the Keratoconus fact sheet available from the Cole Eye Institute.

    Our internationally recognized staff diagnoses and treats the entire spectrum of conditions of the eye. Each year, our physicians see more than 150,000 patients and perform more than 5,000 surgeries.

    Leadership:

    Since there are many varieties of corneal transplantation, your corneal surgeon will help recommend the best option for you and your condition.

    Types

    1. Full-thickness (penetrating) keratoplasty is used for many conditions that affect multiple layers of the cornea.

    2. Endothelial transplants such as Descemet's stripping automated endothelial keratoplasty are used to treat conditions affecting primarily the back layer of the cornea such as Fuchs endothelial dystrophy and bullous keratopathy. It avoids a large surgical wound, minimizes visual distortion from astigmatism, and provides a more rapid visual recovery than penetrating keratoplasty for certain conditions.

    3. Deep anterior lamellar keratoplasty (DALK) can be attempted for conditions such as keratoconus and corneal stromal scar. While technically challenging, DALK attempts to preserve the patient's normal endothelium while replacing all the tissue in front of that layer, thus providing a lower rate of graft rejection. If the delicate back layers of the cornea cannot be preserved during surgery, the procedure is easily converted to a penetrating keratoplasty without the need to reschedule surgery.

    4. Keratoprosthesis is a very specialized type of transplant consisting of a hybrid transplant of donor corneal tissue and a rigid plastic central optic. It is reserved for severe corneal and ocular surface disease. For carefully selected patients, it can provide a clear window for vision in an eye that has failed traditional corneal transplants. Strict adherence to postoperative care is a key to avoiding complications, which are more common than after traditional transplants.

    After surgery, it is important not to put any pressure on the eye. It is best not even to touch or rub anywhere near the eye, so the doctor might put a shield over it. Wearing glasses or sunglasses will also help protect the eye.

    Your doctor will prescribe eye drops to help the eye heal and prevent infection. It is necessary to keep using some of these medications for several months after a corneal transplant. Without these medications, the eye is much more likely to have problems with the new corneal tissue.

    Full recovery of your eyesight could take up to one year. It is important to be patient and let the swelling go down. You are not going to see perfectly over night or in a few days. Patients who have successful corneal transplants report good vision for years.

    You Play the Largest Role in Your Recovery

    The best way to avoid problems after corneal transplantation is to follow all of your doctor's advice, including using all medications as recommended and keeping all follow-up appointments.

    At these appointments, the doctor will check your vision in the eye with the transplant. It is not unusual for that eye to have vision that is very different from the other eye. This difference can be very disturbing, but eyeglasses or contact lenses can improve the situation. Vision can change rapidly after corneal transplantation, so it is necessary to visit the eye doctor more often than usual.

    You should be aware that in a small number of cases, the new corneal tissue is rejected by the body even though the operation was successful and all medications were taken correctly.

    Your doctors cannot predict exactly how your body will respond to a transplant. It is never fully known how the condition that caused your organ disease will affect your new, transplanted organ. The operation itself is complex and the risks remain high for many patients. After the transplant, you may still need to have  biopsies, surgeries, other procedures, or readmissions to the hospital.

    Cleveland Clinic’s pediatric transplant program began in 1963 with the goal of providing the most normal life possible for young patients. Pediatric and adolescent patients are admitted to Cleveland Clinic Children’s. Cleveland Clinic Children’s provides state-of-the-art care in a homelike setting. In addition, because the family is recognized as an important part of a hospitalized child’s recovery, our hospital rooms are designed to enable a parent to spend the night in the room with his or her child.

    For more information on Cleveland Clinic’s pediatric transplant program, please call 216.444.6123.

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    To find a transplant specialist for your needs, contact the Transplant Center at 216.444.2394 (or toll-free 800.223.2273, ext. 42394)

    This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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