Our Summary

The paper discusses the evolution of keratoplasty, a surgical procedure to replace a part of the cornea. Since its introduction in 1905, the techniques have improved, allowing surgeons to use complex graft designs to enhance wound strength, speed up healing, and hasten vision recovery.

Initial advancements were only for penetrating procedures, but now improvements are also applicable to less invasive surgeries. The introduction of a tool called femtosecond laser has increased the variety of graft designs due to its precision in cutting complex wound edges.

The paper reviews the variety of grafts currently in use and discusses their respective pros and cons compared to traditional keratoplasty.

FAQs

  1. What is keratoplasty and when was it introduced?
  2. How has the introduction of the femtosecond laser improved keratoplasty procedures?
  3. What are the differences between the variety of grafts currently in use in keratoplasty?

Doctor’s Tip

One helpful tip a doctor might tell a patient about corneal transplant is to follow all post-operative care instructions carefully to ensure proper healing and avoid complications. This may include using prescribed eye drops, wearing an eye shield at night, avoiding rubbing or touching the eye, and attending follow-up appointments with the surgeon. It is also important to protect the eye from injury and avoid activities that could put strain on the eye during the recovery period.

Suitable For

Patients who may be recommended for a corneal transplant include those with the following conditions:

  1. Corneal scarring: Scarring of the cornea can affect vision and may require a transplant to improve visual acuity.

  2. Keratoconus: This is a progressive condition in which the cornea becomes thin and bulges outward, causing vision problems. A corneal transplant may be recommended in severe cases.

  3. Corneal dystrophies: These are inherited conditions that cause progressive damage to the cornea, leading to vision impairment. A transplant may be necessary to improve vision.

  4. Corneal ulcers: Severe infections or ulcers in the cornea can cause scarring and vision loss, necessitating a transplant.

  5. Corneal edema: Swelling of the cornea can lead to cloudy vision and may require a transplant to restore clarity.

  6. Previous corneal transplant failure: In cases where a previous transplant has failed, a repeat transplant may be recommended.

  7. Trauma: Injuries to the cornea, such as deep cuts or burns, may require a transplant to restore vision.

Overall, patients with significant corneal damage or vision impairment that cannot be corrected with glasses or contact lenses may be recommended for a corneal transplant. It is important for patients to undergo a thorough evaluation by an ophthalmologist to determine if a transplant is the best course of treatment for their specific condition.

Timeline

Before a corneal transplant, a patient typically experiences vision loss, corneal scarring, pain, and discomfort. They may undergo various treatments such as medications, contact lenses, or other surgical interventions to manage their condition.

After a corneal transplant, the patient will have to undergo a period of recovery where they will need to follow post-operative care instructions provided by their surgeon. This may include using eye drops, avoiding strenuous activities, and attending follow-up appointments to monitor the healing process. It may take several months for the patient to fully recover and regain their vision.

What to Ask Your Doctor

Some questions a patient should ask their doctor about corneal transplant include:

  1. What type of corneal transplant procedure do you recommend for my specific condition?
  2. What are the potential risks and complications associated with the procedure?
  3. What is the success rate of the procedure for patients with similar conditions to mine?
  4. How long is the recovery process expected to take, and what can I expect during the recovery period?
  5. Will I need to take any medications or follow a specific post-operative care regimen?
  6. How soon can I expect to notice improvements in my vision following the surgery?
  7. Are there any alternative treatments or procedures that I should consider before opting for a corneal transplant?
  8. What is the long-term outlook for my vision and eye health following the procedure?
  9. How often will I need to follow up with you after the surgery for monitoring and evaluation?
  10. Are there any lifestyle changes or precautions I should take to protect my eye health after the transplant?

Reference

Authors: Sahay P, Stevenson LJ, Agarwal T, Sharma B, Sharma N, Vajpayee RB. Journal: Br J Ophthalmol. 2021 Jan;105(1):9-16. doi: 10.1136/bjophthalmol-2019-315754. Epub 2020 Mar 25. PMID: 32217546