Our Summary

This research paper reviews the progress in treating corneal endothelial diseases, which are a leading cause of corneal transplants. In the past 15 years, a new procedure called endothelial keratoplasty (EK) has significantly changed the way these transplants are done. In this procedure, doctors selectively replace only the diseased part of the cornea, leading to quicker recovery, lower chances of the body rejecting the transplant, and longer-lasting results. However, there are still challenges. One of the biggest is finding suitable donor corneas. Other problems include the need for highly specialized skills, the high cost of the procedure, and the risk of rejection or failure of the transplant. The paper also discusses ongoing research into alternatives to traditional transplants, including regenerative medicine and cell-based therapies.

FAQs

  1. What is endothelial keratoplasty (EK) and how has it improved corneal transplants?
  2. What are the current challenges in conducting endothelial keratoplasty (EK)?
  3. What are the possible alternatives to traditional corneal transplants being researched?

Doctor’s Tip

One helpful tip a doctor might tell a patient about corneal transplant is to follow all post-operative instructions carefully to ensure the best possible outcome. This may include taking prescribed medications, attending follow-up appointments, and avoiding activities that could harm the healing process. It’s also important to communicate any concerns or changes in vision to your doctor promptly. By following these recommendations, patients can increase their chances of a successful corneal transplant and improved vision.

Suitable For

Patients who are typically recommended for a corneal transplant are those with corneal endothelial diseases such as Fuchs’ dystrophy, bullous keratopathy, and corneal edema. These conditions can cause vision loss, pain, and discomfort, and may not respond well to other treatments such as medications or contact lenses. Patients with corneal scarring from infections, trauma, or previous surgeries may also benefit from a corneal transplant to improve their vision and quality of life.

In some cases, patients with keratoconus, a progressive thinning and bulging of the cornea, may also be recommended for a corneal transplant if their vision cannot be corrected with glasses or contact lenses. Additionally, patients with corneal degenerations or dystrophies that affect the clarity of the cornea, such as lattice dystrophy or granular dystrophy, may also be candidates for a corneal transplant.

Overall, corneal transplants are recommended for patients who have significant vision loss or impairment due to corneal diseases that cannot be effectively treated with other methods, and who are healthy enough to undergo the surgical procedure and post-operative care. It is important for patients to discuss their options with an ophthalmologist or corneal specialist to determine if a corneal transplant is the best treatment option for their specific condition.

Timeline

Before the corneal transplant:

  • Patient experiences blurry vision, pain, and sensitivity to light due to corneal endothelial disease
  • Patient undergoes a consultation with an ophthalmologist to determine if a corneal transplant is necessary
  • Patient is put on a waiting list to receive a donor cornea
  • Patient undergoes pre-operative tests and evaluations to ensure they are a suitable candidate for the transplant

After the corneal transplant:

  • Patient undergoes the corneal transplant surgery, which involves removing the damaged cornea and replacing it with a healthy donor cornea
  • Patient may experience some discomfort and blurry vision in the days following the surgery
  • Patient is prescribed eye drops and medications to prevent infection and rejection of the transplant
  • Patient attends follow-up appointments to monitor the healing process and adjust medications as needed
  • Patient gradually experiences improved vision and reduced symptoms as the transplanted cornea heals and integrates with the surrounding tissue
  • Patient may need to wear glasses or contact lenses to achieve optimal vision after the transplant
  • Patient continues to have regular check-ups with their ophthalmologist to monitor the long-term success of the transplant.

What to Ask Your Doctor

  1. What is the success rate of corneal transplant surgery in general and specifically for my condition?
  2. What are the potential risks and complications associated with corneal transplant surgery?
  3. How long is the recovery process and what can I expect in terms of visual outcomes?
  4. Will I need to take immunosuppressant medication to prevent rejection of the transplant?
  5. How long will the transplanted cornea last and are there any factors that could affect its longevity?
  6. What are the alternatives to traditional corneal transplant surgery and are they suitable for my condition?
  7. How many corneal transplants has the surgeon performed and what is their success rate?
  8. How can I find a suitable donor cornea and what is the process for obtaining one?
  9. Are there any lifestyle changes or precautions I should take after the surgery to ensure the success of the transplant?
  10. Are there any clinical trials or new advancements in corneal transplant surgery that I should be aware of?

Reference

Authors: Ong HS, Ang M, Mehta JS. Journal: Br J Ophthalmol. 2021 Apr;105(4):454-467. doi: 10.1136/bjophthalmol-2020-316149. Epub 2020 Jul 24. PMID: 32709756