Our Summary

The first human cornea transplant was carried out in 1905 in the Czech Republic. However, performing this operation on high-risk patients, such as those with inflamed corneas, is still challenging. This is mainly due to the body’s immune system rejecting the new cornea, which is the leading cause of failure in such transplants. One potential solution is immunosuppressive treatment, which is designed to prevent the body from rejecting the new cornea. There is some understanding of how the body’s immune system causes rejection, but the specific role of donor-specific antibodies (DSA), which are proteins produced by the immune system, is unclear. Understanding the role of DSAs in cornea transplant rejection could improve treatment strategies and lead to personalized treatment plans for these patients.

FAQs

  1. When was the first human cornea transplant performed and where?
  2. Why is performing cornea transplants on high-risk patients, such as those with inflamed corneas, so challenging?
  3. How might understanding the role of donor-specific antibodies (DSAs) improve treatment strategies for cornea transplants?

Doctor’s Tip

One tip a doctor might give a patient about corneal transplant is to closely follow the post-operative care instructions provided by the medical team. 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 a successful recovery and reduce the risk of complications.

Suitable For

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

  1. Keratoconus: a progressive thinning and bulging of the cornea, leading to distorted vision.
  2. Fuchs’ dystrophy: a condition where the innermost layer of the cornea gradually deteriorates, causing vision problems.
  3. Corneal scarring: caused by injury, infection, or previous eye surgery, leading to impaired vision.
  4. Corneal ulcers: open sores on the cornea that may not heal properly, leading to vision loss.
  5. Corneal ectasia: a condition where the cornea becomes abnormally thin and bulges outward, causing vision problems.
  6. Corneal edema: swelling of the cornea due to fluid accumulation, leading to vision impairment.
  7. Previous corneal transplant failure: in cases where a previous corneal transplant has failed, a repeat transplant may be recommended.

It is important for patients to undergo a thorough evaluation by an ophthalmologist to determine if a corneal transplant is the best treatment option for their specific condition.

Timeline

  1. Consultation with an ophthalmologist: The patient will initially visit an ophthalmologist for a comprehensive eye examination to determine if a corneal transplant is necessary.

  2. Evaluation for corneal transplant: If the ophthalmologist determines that a corneal transplant is needed, the patient will undergo further testing to assess their suitability for the procedure.

  3. Waiting for a donor cornea: Once deemed eligible for a corneal transplant, the patient will be placed on a waiting list for a suitable donor cornea.

  4. Surgery: When a donor cornea becomes available, the patient will undergo the corneal transplant surgery, which involves replacing the damaged or diseased cornea with the donor cornea.

  5. Post-operative care: After the surgery, the patient will need to follow a strict post-operative care regimen, which may include using eye drops, wearing an eye patch, and attending follow-up appointments with their ophthalmologist.

  6. Recovery and healing: The patient will need time to recover and allow the transplanted cornea to heal properly. During this time, the patient may experience blurred vision, sensitivity to light, and discomfort.

  7. Monitoring for rejection: The patient will be closely monitored for signs of rejection, which may include redness, pain, decreased vision, and sensitivity to light. If rejection occurs, the patient may need additional treatment, such as immunosuppressive medications.

  8. Long-term care: The patient will require long-term follow-up care to ensure the success of the corneal transplant and monitor for any complications. Regular eye exams and monitoring of the transplanted cornea will be essential for maintaining good eye health.

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 the surgery?
  3. How long is the recovery process and what can I expect during this time?
  4. Will I need to take immunosuppressive medications after the surgery?
  5. How often will I need to follow-up with my doctor after the transplant?
  6. What signs or symptoms should I watch for that may indicate rejection of the new cornea?
  7. Are there any lifestyle changes or precautions I need to take after the surgery?
  8. What is the likelihood of needing a second corneal transplant in the future?
  9. Are there any alternative treatments or therapies that may be beneficial for my specific situation?
  10. Can you provide me with more information about the role of donor-specific antibodies in cornea transplant rejection and how this may impact my treatment plan?

Reference

Authors: Major J, Foroncewicz B, Szaflik JP, Mucha K. Journal: Arch Immunol Ther Exp (Warsz). 2021 Nov 6;69(1):32. doi: 10.1007/s00005-021-00636-3. PMID: 34741683