Ophthalmologists (medical eye doctors) perform over 40,000 corneal transplants each year in the United States. Of all transplant surgery done today including hearts, lungs and kidneys, corneal transplants are by far the most common and successful.

What is the cornea?

The cornea is the clear front of the eye that covers the colored iris and the round pupil. Light is focused while passing through the cornea so we can see. To stay clear the cornea must be healthy.

How can an unhealthy cornea affect vision?

If the cornea is damaged it may become swollen or scarred. In either case, its smoothness and clarity may be lost. The scars, swelling or an irregular shape cause the cornea to scatter or distort light, resulting in glare or blurred vision.

A corneal transplant is needed if:

• Vision cannot be corrected satisfactorily;
• Painful swelling cannot be relieved by medications or special contact lenses.
• Corneal failure after other eye surgery, such as cataract surgery;
• Keratoconus, a steep curving of the cornea;
• Hereditary corneal failure, such as Fuch's cornea;
• Scarring after infections, especially after herpes;
• Rejection after first corneal transplant;
• Scarring after injury.
• Complications from LASIK (lamellar transplants).

Before surgery :

Once you and your ophthalmologist decide you need a corneal transplant, your name is put on a list at the local eye bank. Usually the wait is short.

Before a cornea is released for transplant, the eye bank tests the human donor for the viruses that cause hepatitis and AIDS. The cornea is carefully checked for clarity.

Your ophthalmologist may request that you have a physical examination and other special tests. If you usually take medications, ask your ophthalmologist if you should continue them.

The day of surgery :

Surgery is often done on an outpatient basis. You may be asked to skip breakfast, depending on the time of your surgery. Once you arrive for surgery, you will be given eye drops and sometimes medications to help you relax.

The operation is painless. Anesthesia is either local or general, depending on your age, medical condition and eye disease. You will not see the surgery while it is happening, and will not have to worry about keeping your eye open or closed.

The operation:

The eyelids are gently opened. Looking through a surgical microscope, the ophthalmologist measures the eye for the size for the corneal transplant.

The diseased or injured cornea is carefully removed from the eye. Any necessary additional work within the eye, such as removal of a cataract, is completed. Then the clear donor cornea is sewn into place.

When the operation is over, the ophthalmologist will usually place a shield over your eye.

After surgery:

If you are an outpatient, you may go home after a short stay in the recovery area. You should plan to have someone else drive you home. An examination at the doctor's office will be scheduled for the following day.

You will need to:

• Use the eye drops as prescribed;
• Be careful not to rub or press on your eye;
• Use over-the-counter pain medicine, if necessary;
• Continue normal daily activities except exercise;
• Ask your doctor when you can begin driving;
• Wear eyeglasses or an eye shield as advised by your doctor.

Your ophthalmologist will decide when to remove the stitches, depending upon the health of the eye and rate of healing.

Usually, it will be several months, at least, before stitches are removed.

What can I expect after transplant surgery?

Cornea Transplants are done on an outpatient basis. The procedure itself takes 45 minutes to 75 minutes depending on the complexity of the situation. You should expect to spend the whole morning at the outpatient surgery center however.

When you leave the hospital you will wear a patch and a shield. This will be removed the next day at your follow up visit at the doctor's office. After that you will be wearing dark glasses during the day and a protective shield at night only. Your vision will be blurry for approximately 3 - 6 months.

At 3 months you will start having your sutures removed and they should all be removed by the end of 6 months a little longer if you are older. At the end of 6 months you will be fitted with glasses or contact lenses. During the whole 6-month period you will take anti -rejection drops and antibiotic drops approximately 4 times a day.

For the first 6 weeks heavy exercise and lifting of heavy objects will be prohibited but otherwise you can live a normal life. Most people return to work 3-7 days after their surgery depending on the type of work they do.