Alex W. Cohen, MD, PhD - What's it like: To have a corneal transplant

by Jaclyn Cosgrove Modified: October 12, 2014 at 10:00 am •  Published: October 12, 2014
The Oklahoman

Watch the interview here, http://newsok.com/whats-it-like-to-have-a-corneal-transplant/article/5352712


Why do people need corneal transplants?

The cornea is the clear outer region of the front part of the eye. A corneal transplant, or keratoplasty, is one of the most common types of transplants performed. The transplant can help restore vision, reduce pain and improve the appearance of a damaged or diseased cornea.

A person might need a corneal transplant because he or she suffers from vision problems because of a thinning cornea. Another reason to get a corneal transplant would be because of scarring of the cornea from severe infections or injuries. Also, the only cure for people who suffer from Fuchs’ dystrophy — an eye disease that causes the cells lining the inner surface of the cornea to slowly start to die — is a corneal transplant.

Unlike other transplants, there is generally no wait time for a corneal transplant.

Also, it’s not required to match donors for corneal transplants.

What happens during surgery?

There are two main types of corneal transplant: partial-thickness transplants and full-thickness transplants.

For a full-thickness transplant, you’ll be placed under some version of anesthesia. You might be partially awake, although it will depend on your surgery needs. The surgeon will measure your cornea, mark it and then prepare the donor tissue, which usually comes from a person who has died and donated their tissue. For people with multiple failed transplants, a surgeon might use an artificial cornea.

The surgeon will use a device known as a trephine, similar to a cookie cutter, to remove the central portion of the cornea. The surgical team will cut the piece of the donation that they need, and quickly, place the new cornea on the eye. The donated cornea is stitched in place with usually between 16 and 24 tiny sutures. While stitching, the surgical team will place fluid in the eye to better ensure the eye doesn’t decompress, a major but rare complication of corneal transplants. If the eye decompresses, its contents can come out of the hole made when the cornea is removed.

After surgery, you likely will wake up with a patch and shield over your eye. Unlike cataract surgery, your vision won’t likely be drastically improved promptly after surgery.

What’s the cost?

The tissue itself costs between $1,000 to $2,000. The surgery cost ranges from $16,500 to about $20,000, although this can vary widely, depending on your surgeon and the hospital.

Insurance, including Medicare, frequently covers the surgery. For people who are uninsured, some facilities offer assistance programs that offer the surgery at a low cost or no charge.

What are the risks of surgery?

Because it’s a transplant, there’s a risk of rejection. Estimates of rejection rates vary among medical research. Some research shows rejection occurs in about one out of three patients in the first five years. Other research suggests rejection occurs in about 20 percent of cornea transplants. And another estimate is that about 10 percent of transplants over 10 years for first time full thickness transplant will end in rejection, while about 5 percent over 10 years will fail.

Other risks include bleeding, infection, glaucoma, cataracts, scarring and swelling of the cornea.

To reduce the risk of rejection, your doctor likely will prescribe steroid eye drops that you will take regularly for at least a year, usually about four times a day to start with. The number of times you have to use the eye drops daily usually reduces over time. However, some patients must take the eye drops for the rest of their lives.

Patients with full-thickness transplants are at risk of dislocating their transplant if they have trauma to their eye, such as being punched in the face. This can cause the transplant to come apart, and the inside of the eye can come out.

What’s the recovery time?

It takes about a year for full-thickness transplant patients to fully recovery and notice an improvement in vision. Unlike your skin, which has a lot of blood vessels, the cornea generally doesn’t have any blood vessels. This means the wound can take a year before its solid enough to take the stitches out.

Also, the body heals irregularly, meaning your eye could heal tighter in one area than in another. This can cause astigmatism, where the cornea is no longer round. When it’s not round, it doesn’t bend light properly, so it can make it difficult for you to see. Your doctor will remove stitches periodically over the year after surgery to try to normalize the surface of the eye so you can see.

Meanwhile, it will take between one month and three months for a partial-thickness transplant to heal. For this procedure, you will have an air bubble in your eye that floats the new tissue up against the old tissue. That tissue and air bubble have to sit side by side for 24 hours to 72 hours for the tissues to stick together. This means a patient will be on his or her back for one to three days.

Full-thickness transplants can last for several years. Because partial-thickness transplants have been performed in the U.S. for only about 10 years, long-range data isn’t available. However, projections show that these transplants should last as long as full-thickness transplants.

Source: Dr. Alex Cohen, an ophthalmologist at Dean McGee Eye Institute; the Mayo Clinic; the National Institutes of Health; National Eye Institute; Cornea Research Foundation of America; and The Eye Bank Association of America.

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