Clearer Vision Ahead: Everything You Need to Know About Cornea Transplants

A cornea transplant also called corneal transplantation or keratoplasty is a surgical procedure where a damaged or diseased cornea is replaced by a donated corneal tissue. The cornea is the clear, dome-shaped surface of the eye that plays a critical role in focusing light for clear vision. Corneal damage can significantly impair vision and may require a transplant. Here's an overview of who might need one, the causes, symptoms, and treatment options:

Who Needs a Cornea Transplant?

Corneal transplants are needed when the cornea becomes cloudy, scarred, or damaged, leading to impaired vision or pain that cannot be treated by other means. Conditions that may require a transplant include:

1. Keratoconus: A progressive eye disease in which the normally round cornea thins and bulges into a cone shape, distorting vision.
2. Fuchs' Dystrophy: A hereditary condition where the cells in the corneal endothelium innermost layer gradually deteriorate, leading to corneal swelling and vision loss.
3. Corneal Scarring: Injury, infection such as herpes simplex virus, or trauma can cause scars on the cornea that impair vision.
4. Corneal Edema: Swelling of the cornea, often due to endothelial cell loss or damage from previous eye surgeries like cataract surgery.
5. Corneal Infections: Severe infections like bacterial keratitis or fungal infections that damage the cornea.
6. Chemical Burns: Exposure to harmful chemicals that damage the cornea.
7. Corneal Ulcers: Severe ulcers can result from infections, injury, or contact lens misuse, causing deep damage to the cornea.

Symptoms of Corneal Damage

When the cornea is damaged or diseased, symptoms can include:

• Blurred or distorted vision: Common when the cornea becomes irregular or scarred.
• Eye pain or discomfort: Often associated with corneal injuries or infections.
• Sensitivity to light - photophobia: Light can become intolerable due to corneal conditions.
• Tearing or discharge: The eye may produce excess tears or have discharge.
• Cloudy or hazy vision: As the cornea becomes less transparent, vision may appear foggy or hazy.
• Swelling of the eye: Edema or fluid buildup in the cornea can cause the eye to look swollen or puffy.

Types of Corneal Transplants

1. Penetrating Keratoplasty - PK: A full-thickness cornea transplant where all layers of the damaged cornea are replaced.
2. Endothelial Keratoplasty - EK: A partial-thickness transplant that replaces only the innermost layer endothelium, often used for conditions like Fuchs' dystrophy.
• Descemet's Stripping Endothelial Keratoplasty - DSEK
• Descemet Membrane Endothelial Keratoplasty - DMEK
3. Anterior Lamellar Keratoplasty - ALK: A partial-thickness transplant that replaces the outer layers of the cornea, leaving the inner layer intact.
4. Deep Anterior Lamellar Keratoplasty - DALK: Replaces only the outer layers of the cornea, used for diseases that do not affect the inner layers.

Treatment Options

Before opting for a cornea transplant, other treatment options may be considered depending on the condition:

• Medication: Eye drops or ointments may treat infections, reduce inflammation, or manage pain.
• Contact lenses: Special contact lenses, such as scleral lenses, can sometimes improve vision for people with keratoconus or corneal scars.
• Cross-linking: In the case of early-stage keratoconus, corneal cross-linking can help halt disease progression.

Intacs: Small plastic inserts placed in the cornea to flatten its shape and improve vision, often used in keratoconus cases.