A complete pre-operative evaluation will be required prior to surgery.
The procedure usually takes approximately one hour and the majority of adult patients may be operated on under local anesthesia. General anesthesia will likely be required for children, anxious, or uncooperative patients. After the anesthetic is given, the surgeon usually sews a ring to the ocular surface to support the eye. The donor clear central part of the cornea is prepared using a punch or corneal trephine to create the corneal “button”. The cornea button will become the transplanted cornea. The diseased, or scarred, cornea is then removed using a corneal trephine, creating a “bed” for the transplant cornea. In one form of corneal transplant (penatrating keratoplasty), the disc removed is the entire thickness of the cornea and so is the replacement disc. In lamellar keratoplasty, on the other hand, only the outer layer of the cornea is removed and replaced. Finally, the donor cornea is gently sewn into place with ultra-fine sutures (approx. One-third the thickness of human hair, or less).
Corneal transplantation may be combined with other procedures, particularly cataract extraction with intraocular lens implantation.
Postoperatively, eye drops will be prescribed for the patient to use for several weeks after surgery. These drops include antibiotics to prevent infection as well as corticosteroids to reduce inflammation and prevent graft rejection. Within days following the corneal surgery, the patient is able to resume light activity with proper restrictions. Patients should expect very gradual recovery of vision. The healing process may vary greatly from one individual to the next. In fact, the best vision may not be obtained for six to 12 months or more following surgery, even though vision may be improved from the first day after surgery in some cases. The surgeon will likely begin to remove some sutures from the cornea within a few weeks to a few months after surgery. However, all of the sutures need not be removed to help alleviate astigmatism once the cornea begins to show of being securely healed into place. During the postoperative period, the surgeon monitors the cornea’s healing with special computer mapping called corneal topography. This allows the doctor to evaluate the shape of the new cornea.
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