Our Summary

This research aimed to find out why certain corneal transplant surgeries can fail. The study looked at four types of corneal transplants: penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), Descemet stripping automated endothelial keratoplasty (DSAEK), and Descemet membrane endothelial keratoplasty (DMEK).

The researchers looked at the medical records of patients who had these transplants between 2001 and 2016. They defined a transplant failure as any irreversible loss of transparency in the graft that could affect vision. Transplant failures were categorized into four groups: primary graft failure, immune system rejection, non-rejection (which includes various issues like glaucoma, diseases of the ocular surface, and trauma), and specific causes related to lamellar keratoplasty failure.

For the PK transplants, the main cause of failure was immune system rejection, accounting for 28.2% of failures. For re-grafts, immune system rejection was again the main cause of failure, accounting for 34.0% of cases. For the DALK group, the main cause of failure was diseases of the ocular surface, accounting for 37.8% of failures. In the DSAEK group, the main cause of failure was endothelial decompensation without rejection, accounting for 31.9% of failures. In the DMEK group, primary graft failure was the main cause of failure, accounting for 64.1% of failures.

In simple terms, the study found that immune system rejection was the main reason why PK transplants fail, diseases of the ocular surface were the leading cause of failure in DALK transplants, endothelial decompensation without rejection was the main cause of failure in DSAEK transplants, and primary graft failure was the main cause of failure in DMEK transplants.

FAQs

  1. What types of corneal transplants were studied in this research?
  2. How did the researchers define a corneal transplant failure?
  3. What were the main causes of failure for each type of corneal transplant studied?

Doctor’s Tip

One helpful tip a doctor might tell a patient about corneal transplant is to closely follow the post-operative care instructions provided by their surgeon. This can help reduce the risk of complications and increase the likelihood of a successful outcome. It is important to attend all follow-up appointments, take prescribed medications as directed, and avoid activities that could potentially harm the eye during the healing process. Communicating any concerns or changes in vision to the surgeon promptly is also key in ensuring the best possible outcome following a corneal transplant.

Suitable For

Patients who may be recommended for corneal transplant surgery include those with:

  1. Advanced keratoconus: Keratoconus is a progressive eye disease that causes the cornea to thin and change shape, leading to distorted vision. In severe cases where contact lenses or other treatments are no longer effective, a corneal transplant may be recommended.

  2. Corneal scarring: Scarring of the cornea due to injury, infection, or previous surgeries can cause vision problems that may require a corneal transplant to restore vision.

  3. Fuch’s dystrophy: Fuch’s dystrophy is a genetic condition that causes the endothelial cells of the cornea to deteriorate, leading to corneal swelling and vision problems. In advanced cases, a corneal transplant may be necessary.

  4. Corneal edema: Corneal edema, or swelling of the cornea, can occur due to various factors such as trauma, surgery, or certain eye conditions. Severe cases of corneal edema may require a corneal transplant to improve vision.

  5. Corneal infections: Severe corneal infections that do not respond to antibiotics or other treatments may require a corneal transplant to remove the infected tissue and restore vision.

  6. Corneal thinning disorders: Disorders such as keratoconus, pellucid marginal degeneration, or Terrien’s marginal degeneration can cause thinning of the cornea and vision problems that may necessitate a corneal transplant.

  7. Corneal dystrophies: Inherited corneal dystrophies such as lattice dystrophy, granular dystrophy, or macular dystrophy can lead to vision loss and may require a corneal transplant to improve vision.

Overall, patients with conditions that affect the clarity, shape, or thickness of the cornea and cannot be effectively treated with other methods may be recommended for a corneal transplant. Each patient’s case is unique, and the decision to undergo a corneal transplant should be made in consultation with an ophthalmologist or corneal specialist.

Timeline

Before a corneal transplant, a patient may experience vision loss, blurry vision, pain, discomfort, and difficulty seeing at night. They may also have been diagnosed with conditions such as keratoconus, corneal scarring, or Fuchs’ dystrophy that require a transplant.

After a corneal transplant, the patient will undergo a period of recovery where they may experience discomfort, sensitivity to light, and blurry vision. They will need to use eye drops and follow up with their doctor regularly for monitoring. Over time, their vision should improve as the new cornea heals and integrates into their eye. However, there is a risk of transplant failure due to various factors such as immune system rejection, diseases of the ocular surface, endothelial decompensation, or primary graft failure. Regular follow-up appointments and adherence to medication regimens are crucial to prevent and address any potential issues that may arise after the transplant.

What to Ask Your Doctor

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

  1. What type of corneal transplant surgery is recommended for my condition?
  2. What are the potential risks and complications of the surgery?
  3. How long is the recovery process and what can I expect during this time?
  4. What are the success rates of the specific type of corneal transplant being recommended?
  5. What are the signs of rejection or failure of the transplant that I should watch out for?
  6. How often will I need to follow up with the doctor post-surgery?
  7. Are there any specific medications or treatments I will need to take after the surgery to prevent rejection?
  8. How likely is it that I will need a re-graft or additional surgery in the future?
  9. Are there any lifestyle changes I should make to improve the success of the transplant?
  10. Are there any specific factors in my medical history or health that may impact the success of the surgery?

Reference

Authors: Gómez-Benlloch A, Montesel A, Pareja-Aricò L, Mingo-Botín D, Michael R, Barraquer RI, Alió J. Journal: Acta Ophthalmol. 2021 Sep;99(6):e922-e928. doi: 10.1111/aos.14708. Epub 2021 Jan 9. PMID: 33421330