Our Summary

This research paper discusses a procedure called a penetrating keratoplasty, which is a type of tissue transplant often used to treat eye conditions. The success of this procedure relies heavily on the health of the surface of the eye and the immune system’s ability to accept the new tissue. If these conditions aren’t met, there’s a higher chance the transplant will fail, leading to corneal blindness.

For over 200 years, scientists have been trying to create the perfect artificial cornea to treat severe corneal blindness. There have been many challenges, but in recent years, significant progress has been made. The keratoprosthesis, a type of artificial cornea, is now often the first choice for certain conditions and isn’t just a last resort.

The paper specifically looks at the Boston keratoprosthesis type 1, a newer treatment for severe corneal blindness used when other corneal transplants have failed. Changes in the design of the artificial cornea, the way the surgery is performed, and the care given after surgery have all improved the chances of success and made the procedure more popular. It has also reduced the risk of complications, making it a safe and effective option for treating certain corneal issues.

However, some complications can still occur and need to be managed to further improve the outcomes for patients with corneal blindness.

FAQs

  1. What is a penetrating keratoplasty and when is it used?
  2. What is the Boston keratoprosthesis type 1 and how has it improved the success rates of corneal transplants?
  3. What are some complications that can occur during or after a corneal transplant?

Doctor’s Tip

One helpful tip a doctor might give a patient about corneal transplant is to follow all post-operative care instructions carefully. This includes taking prescribed medications, attending follow-up appointments, and avoiding activities that could put strain on the eye. It’s important to communicate any changes or concerns to your doctor promptly to ensure the best possible outcome for your corneal transplant.

Suitable For

Patients who are typically recommended for a corneal transplant, whether it be a traditional penetrating keratoplasty or a newer keratoprosthesis, include those with conditions such as:

  1. Keratoconus: This is a condition where the cornea thins and bulges out into a cone shape, leading to distorted vision.

  2. Fuchs’ dystrophy: This is a genetic condition where cells in the cornea’s inner layer deteriorate, leading to swelling and cloudiness.

  3. Scarring from infections or injuries: Severe scarring on the cornea can cause vision problems that may require a transplant to restore clear vision.

  4. Corneal ulcers: These are open sores on the cornea that can result from infections or injuries and may require a transplant if they are severe and do not heal properly.

  5. Previous failed corneal transplants: If a patient has had one or more failed corneal transplants, they may be recommended for a newer type of transplant like the Boston keratoprosthesis.

In general, patients who have significant vision loss due to corneal conditions that cannot be corrected with glasses, contact lenses, or other treatments may be candidates for a corneal transplant. It is important for patients to undergo a thorough evaluation by an eye care specialist to determine if a transplant is the best option for their specific condition.

Timeline

Before a corneal transplant:

  1. Patient is diagnosed with a severe corneal condition that cannot be treated effectively with other methods.
  2. Patient undergoes a thorough eye examination and evaluation to determine if they are a good candidate for a corneal transplant.
  3. Patient is placed on a waiting list for a suitable donor cornea.
  4. Once a donor cornea becomes available, the patient undergoes the corneal transplant surgery.

After a corneal transplant:

  1. Patient is closely monitored for signs of rejection or complications in the days and weeks following surgery.
  2. Patient must follow a strict regimen of eye drops and medications to prevent rejection and infection.
  3. Patient attends regular follow-up appointments with their eye care provider to monitor the healing process.
  4. Patient gradually regains vision over time as the new cornea heals and integrates with the surrounding tissue.
  5. Patient may need to undergo additional procedures or treatments to address any complications that arise post-transplant.
  6. In the long term, patient continues to be monitored for any signs of rejection or complications and may require ongoing care to maintain the health of the transplanted cornea.

What to Ask Your Doctor

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

  1. What type of corneal transplant procedure is recommended for my specific condition?
  2. What are the potential risks and complications associated with the surgery?
  3. What is the success rate of the corneal transplant procedure?
  4. How long is the recovery process, and what can I expect during this time?
  5. Will I need to take any medications after the surgery, and if so, what are the potential side effects?
  6. How often will I need to follow up with my doctor after the surgery?
  7. What lifestyle changes or restrictions should I be aware of post-surgery?
  8. What is the long-term outlook for my vision following the corneal transplant?
  9. Are there any alternative treatments or procedures available for my condition?
  10. How experienced is the surgical team in performing corneal transplant procedures, and what is their success rate?

Reference

Authors: Harissi-Dagher M, Slim E. Journal: J Fr Ophtalmol. 2019 Mar;42(3):295-302. doi: 10.1016/j.jfo.2018.08.010. Epub 2019 Mar 8. PMID: 30857801