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Corneal Transplant

The cornea refers to the clear, front surface of your eye. When a corneal transplant is done, officially termed keratoplasty (KP), the central part of the cornea is surgically removed and replaced with a “button” of clear and healthy corneal tissue donated from an eye bank.

According to the National Eye Institute, approximately 40,000 corneal transplants are performed annually in the United States. The overall success rate for keratoplasty is relatively high, yet up to 20% of patients may reject their donor corneas. Aggressive medical treatment with steroids is generally given in response to signs of rejection, and it is often effective at subduing the negative reaction and saving the cornea. At five to ten years after KP surgery, studies report an encouraging success rate of 95% to 99%.

Why are corneal transplants done?

Corneal transplants are typically done when the cornea becomes damaged or scarred in a way that uncorrectable vision problems occur. These types of vision conditions are not resolved by eyeglasses, contact lenses or refractive laser surgery (such as LASIK). Disease or injury is the usual culprit for the vision loss.

Keratoconus is a common reason for needing a corneal transplant. In this degenerative condition, the cornea thins and bulges forward in an irregular cone shape. Rigid gas permeable (GP) contact lenses can treat mild cases by flattening the cornea, yet contacts are not effective when it comes to advanced stages of keratoconus. The National Keratoconus Foundation reports that 20% to 25% of people with keratoconus will require corneal transplant surgery to restore vision. Other corneal degenerative conditions will also result in a need for keratoplasty.

Corneal ectasia is a thinning and bulging of the cornea that sometimes occurs after LASIK or other refractive vision correction procedures. In the event that this happens, a corneal transplant may be needed to restore vision.

Corneal scarring, due to chemical burns, infections and other causes, is an additional reason that a corneal transplant may be indicated. Traumatic injuries to the eye are also commonly responsible.

Corneal Transplant Procedure

Keratoplasty is generally done on an outpatient basis, with no need for overnight hospitalization. Depending upon age, health condition and patient preference, local or general anesthesia is used.

Using a laser or a trephine, this is an instrument similar to a cookie cutter, the surgeon cuts and removes a round section of damaged corneal tissue and then replaces it with the clear donor tissue.

Extremely fine sutures are used to attach the donor button to the remaining cornea. The sutures remain in place for months (sometimes years) until the eye has recuperated, healed fully and is stable.

Recovery from a Corneal Transplant

The total healing time from keratoplasty may last up to a year or longer. At first, vision will be blurred and the site of the corneal transplant may be inflamed. In comparison to the rest of the cornea, the transplanted portion may be slightly thicker. For a few months, eye drops are applied to promote healing and encourage the body to accept the new corneal graft.

A shield or eyeglasses must be worn constantly after surgery in order to protect the healing eye from any bumps. As vision improves, patients may gradually return to normal daily activities.

What happens to vision post-keratoplasty?

Some patients report noticeable improvement as soon as the day after surgery. Yet a great deal of astigmatism is common after a corneal transplant. A patient’s prescription for vision correction tends to fluctuate for a few months after the surgery, and significant vision changes may continue for up to a year.

Hard, gas permeable contact lenses generally provide the sharpest vision after a corneal transplant. This is due to a residual irregularity of the corneal surface. Even with rigid contact lenses, eyeglasses with polycarbonate lenses must be worn in order to provide adequate protection for the eye.

Once the sutures are removed and healing is complete, a laser procedure such as LASIK may be possible and advised. Refractive laser surgery can reduce astigmatism and upgrade quality of vision, sometimes to the point that no eyeglasses or contact lenses are needed.

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Dear Northwood Vision patient,

Here is what we are asking you to do to make a smaller exposure footprint:

  1. If you have any symptoms of loss of taste or smell, upset stomach/diarrhea coughing, fever, difficulty breathing, running nose please reschedule your appointment in 30 days or more.
  2. Wash your hands or use sanitizer immediately upon entering.
  3. Try not to touch any surfaces in the office you do not have to touch (you can push our door open with your foot! Try not to touch your face!)
  4. If you are trying on glasses, we will collect them from you for proper cleaning.
  5. Contact lenses can be shipped to you at no cost with an active rx (minimum 2 boxes)
  6. We will ask that if possible you come alone to the appointment. Guests can wait outside or in the car unless they need to be with you..
  7. If you have been exposed please wear a mask or reschedule in case you are an asymptomatic carrier, masks are encouraged to be worn by each patient if you have one.
  8. We will extend Contact lens prescriptions up to 6 months if recently expired and can direct ship an order to you if you see clearly and your eyes are feeling healthy.
  9. For a fee, we can ship your glasses to you if desired and you can have them adjusted after the shelter in place order is lifted.

Thank you for your patience and understanding during this stressful and trying time. May God bless each of you and keep you well.

Dr. Christopher K. Keats, OD

What is an Eye Emergency? Read more

Routine Care: “I see pretty well in my glasses or contact lenses. I just want to update my frame and / or get some new lenses to optimize my vision. I don’t have any pain or headaches and my eyes feel good and look normal in the mirror to me. I have never been told I have a disease in my eye that needs to be managed. I should definitely wait to come in until the “Shelter at Home” mandate is over. If I am a contact lens wearer, I understand Dr. Keats will allow me to get 3-6 months of contact lenses mailed to me even if my contact lenses are recently expired or close to expiring.”

Emergent Care: “I see poorly and am having difficulty functioning to drive, read, or see my computer. It is affecting my work. Waiting to be seen in 2 months would be very difficult for me to conduct my life.” Another form of emergent care… “I have other symptoms like headaches, red eyes, discharge, or I might have a disease that threatens my sight like diabetes, macular degeneration, glaucoma, a recent onset of flashes and floaters in my vision and so on.” A final type of emergent care would be a patient who realizes, “I am a patient who has a previously scheduled appointment for a medical condition Dr. Keats is managing to protect my sight, so I should plan on coming in for my visit. However, if my overall health is poor and the benefit to risk ratio says I should push this appointment off until the “Shelter at Home” mandate is lifted, it may be wise for me to reschedule for a later date.” In summary, emergent care means it is important that you be seen quickly for the protection of your visual health and current discomfort, or medical health, so you can function to do your work efficiently now and in the future.