What is the cornea?

Your eye has a number of layers. The cornea is the transparent (clear), dome-shaped outer layer in front of the black pupil and coloured iris. Sometimes the cornea can become diseased, causing it to become less clear. This affects your vision.

How does the cornea become diseased?

There are many causes for the cornea becoming diseased. Three common causes need surgery.

• Keratoconus — A condition where the cornea becomes cone-shaped, causing blurred vision.
• Endothelial decompensation — A condition that causes the cornea to become swollen and cloudy.
• Scarring — The cornea can become scarred if you have a serious infection or injury that causes inflammation.

What are the benefits of surgery?

Your vision should improve.

Are there any alternatives to a corneal transplant?

Different types of glasses and contact lenses may help.

If you have keratoconus, sometimes ultraviolet light can stop it becoming worse.

If you have endothelial decompensation, eye drops may be helpful.

What does the operation involve?

Various anaesthetic techniques are possible, including a general anaesthetic or a local anaesthetic that is injected around your eye to numb it. The operation usually takes 1 to 2 hours.

Your surgeon will remove the centre part of your diseased cornea and replace it with a part of a cornea from a donor (someone who has died). Your surgeon may replace all of your cornea (penetrating keratoplasty), the outer layers (deep lamellar keratoplasty) or just the inner layer (endothelial keratoplasty). Your surgeon will use small stitches to seal your eye.

How can I prepare myself for the operation?

Keeping in the same position

If the operation is performed under a local anaesthetic, you will need to lie still and flat during the operation. If you cannot lie still and flat, let your surgeon know.

Your face will be covered with a cloth to allow your surgeon to work on a clean surface. Air will be blown gently towards your nose. If you are claustrophobic (afraid of being in small spaces), let your surgeon know.

Lifestyle changes

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

General complications of any operation

• bleeding
• infection
• allergic reaction to the equipment, materials or medication
• chest infection

Specific complications of this operation

• heavy bleeding inside your eye
• inflammation in your other eye
• leak at your wound
• transferring infection from the donor
• increase in eye pressure
• failure of the transplant

Consequences of this procedure

• pain

How soon will I recover?

You should be able to go home the same day or the day after.

The healthcare team will give you eye drops and sometimes medication to take home.

Do not swim or lift anything heavy until you have checked with your surgeon.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Most people make a good recovery.

It may take up to 2 years for your vision to improve. You may need to have an operation to change the shape of the cornea.

The healthcare team will arrange for you to come back to the clinic regularly so they can check that the transplant is healing well and for signs of rejection.

Summary

Disease of the cornea is a common problem that causes the transparent outer layer of the front of your eye to become less clear. If other treatments do not help, a corneal transplant can be performed to improve your vision.

The operation and treatment information on this page is published under license by Healthdirect Australia from EIDO Healthcare Australia and is protected by copyright laws. Other than for your personal, non-commercial use, you may not copy, print out, download or otherwise reproduce any of the information. The information should not replace advice that your relevant health professional would give you. Medical Illustration Copyright © Medical-Artist.com.

For more on how this information was prepared, click here.