Our Summary

This research paper explains that corneal transplantation, a procedure where a damaged or diseased cornea is replaced by donated corneal tissue, is an effective way to restore sight for people suffering from corneal disorders. The success of this procedure is largely due to the fact that the cornea, the clear front surface of the eye, is ‘immune privileged’, meaning it is less likely to elicit an immune response that could lead to rejection of the transplanted tissue.

However, there are still cases where the body rejects the new cornea, and there’s also a shortage of corneal donor tissue, both of which pose significant challenges.

The study also notes that the cornea does not contain blood vessels, a condition known as ‘avascularity’, which is crucial for the success of corneal transplants. But sometimes, new blood vessels and lymph vessels can form in the cornea, a process known as angiogenesis and lymphangiogenesis respectively, which can disrupt the success of the transplant.

Recent research has focused on these processes and has resulted in therapies that can tackle rejection reactions related to the formation of new blood vessels. Additionally, researchers have been developing new materials to substitute for human donor corneas, which can help address the shortage of donor tissue.

The authors summarize the latest advancements and improvements in corneal transplantation, including our current understanding of how new blood vessels form, the factors that can prevent this formation, and the new materials being used to replace human corneas. They also discuss potential future areas of research in this field.

FAQs

  1. What role does immune privilege play in the success of corneal transplantation?
  2. How has research into angiogenesis and lymphangiogenesis contributed to advancements in corneal transplantation?
  3. What new materials have been developed to address the shortage of corneal donor tissue?

Doctor’s Tip

One helpful tip a doctor might tell a patient about corneal transplant is to follow the post-operative care instructions carefully. This may include using prescribed eye drops, avoiding rubbing or touching the eye, wearing protective eyewear, and attending follow-up appointments. By following these instructions, the patient can help ensure the success of the transplant and reduce the risk of complications.

Suitable For

Patients who are typically recommended for corneal transplant surgery include those with corneal disorders such as corneal opacity, injury, infections, and other conditions that affect the clarity and health of the cornea. These conditions can lead to vision loss and blindness if left untreated. Patients who have not responded to other treatments, such as medication or contact lenses, may be recommended for corneal transplant as a last resort to restore vision.

Corneal transplantation is also recommended for patients who have experienced rejection reactions or complications following a previous corneal transplant, as well as those with corneal scarring or irregularities that cannot be corrected through other means. Additionally, patients with certain genetic disorders or autoimmune diseases that affect the cornea may also benefit from corneal transplant surgery.

Overall, corneal transplant surgery can be a life-changing procedure for patients with vision impairments caused by corneal disorders, and it is typically recommended for those who have exhausted other treatment options.

Timeline

Before corneal transplant:

  1. Patient is diagnosed with a corneal disorder such as opacity, injury, or infection that is affecting their vision.
  2. Patient undergoes various treatments to try to improve their condition, such as medication or eye drops.
  3. If these treatments are unsuccessful, the patient may be recommended for a corneal transplant.
  4. Patient is placed on a waiting list for a corneal donor tissue.
  5. Once a donor is found, the patient undergoes pre-operative testing and evaluation to ensure they are a suitable candidate for the transplant procedure.

After corneal transplant:

  1. Patient undergoes the corneal transplant surgery, which involves replacing the damaged cornea with the donor tissue.
  2. Patient is monitored closely post-operatively for any signs of complications or rejection.
  3. Patient is prescribed medications to help prevent rejection and promote healing.
  4. Patient attends follow-up appointments with their eye doctor to monitor the success of the transplant and make any necessary adjustments to their medication regimen.
  5. Over time, the patient’s vision improves as the transplanted cornea heals and integrates with the surrounding tissue.
  6. Patient may need to continue taking medications and attending regular check-ups to ensure the long-term success of the transplant.

What to Ask Your Doctor

  1. What is the success rate of corneal transplant surgery?
  2. What are the potential risks and complications associated with corneal transplant surgery?
  3. How long is the recovery process after corneal transplant surgery?
  4. Will I need to take immunosuppressant medications after the surgery to prevent rejection?
  5. How long will the transplanted cornea last before another transplant may be needed?
  6. Are there any lifestyle changes I should make after corneal transplant surgery?
  7. How often will I need to follow-up with my doctor after the surgery?
  8. What are the signs of rejection I should watch for after the surgery?
  9. Are there any alternative treatments to corneal transplant surgery that I should consider?
  10. How can I best care for my eyes after corneal transplant surgery to ensure optimal healing and outcomes?

Reference

Authors: Zhong W, Montana M, Santosa SM, Isjwara ID, Huang YH, Han KY, O’Neil C, Wang A, Cortina MS, de la Cruz J, Zhou Q, Rosenblatt MI, Chang JH, Azar DT. Journal: Surv Ophthalmol. 2018 Jul-Aug;63(4):453-479. doi: 10.1016/j.survophthal.2017.12.008. Epub 2017 Dec 27. PMID: 29287709