Our Summary

This research paper discusses corneal transplants, which typically have better short- and long-term results compared to other organ transplants due to the unique immune properties of the eye. However, in many cases, these transplants can still fail or be rejected by the body at similar or even higher rates than other organ transplants.

This paper reviews the latest research into why some corneal transplants are at higher risk of failure, and the role our immune system plays in rejecting these transplants. The authors highlight areas where further research is needed to improve the success rate of high-risk corneal transplants. This includes developing better methods to predict the risk of transplant failure and testing new treatments that can prevent the immune system from rejecting the transplant.

The paper also notes a lack of research into corneal diseases that are common in developing countries and are often caused by infections. Finally, it suggests that researchers working on corneal and other organ transplants could benefit from working more closely together.

FAQs

  1. Why do corneal transplants sometimes fail or get rejected at higher rates than other organ transplants?
  2. What are some of the key areas of research needed to improve the success rate of high-risk corneal transplants?
  3. Why does the paper emphasize the need for more research into corneal diseases common in developing countries?

Doctor’s Tip

One helpful tip a doctor might tell a patient about corneal transplant is to closely follow post-operative care instructions provided by their healthcare team. This may include taking prescribed medications, attending follow-up appointments, and avoiding activities that could potentially harm the transplant. By following these instructions, patients can help ensure the success of their corneal transplant and reduce the risk of complications.

Suitable For

Patients who are typically recommended for corneal transplant include those with:

  1. Corneal scarring or damage from infections, injury, or previous surgeries
  2. Keratoconus, a condition where the cornea becomes thin and cone-shaped
  3. Corneal dystrophies, such as Fuchs’ dystrophy or lattice dystrophy
  4. Corneal degeneration, such as bullous keratopathy
  5. Corneal ulcers that do not respond to medical treatment
  6. Corneal swelling or edema
  7. Corneal ectasia, such as post-LASIK ectasia
  8. Corneal opacities that affect vision
  9. Corneal vascularization

Overall, patients who have significant visual impairment or discomfort due to corneal conditions that cannot be corrected with glasses, contact lenses, or other treatments are potential candidates for corneal transplant. Each patient’s specific condition and medical history will be evaluated by an ophthalmologist to determine if they are suitable for the procedure.

Timeline

Before corneal transplant:

  1. Patient is diagnosed with a corneal disease or condition that cannot be effectively treated with medication or other conservative measures.
  2. Patient undergoes a thorough eye examination and evaluation to determine if they are a suitable candidate for a corneal transplant.
  3. Patient is placed on a waiting list for a donor cornea, which can take weeks to months depending on availability.
  4. Patient is informed about the risks and benefits of the surgery, as well as the potential complications and post-operative care required.

After corneal transplant:

  1. Patient undergoes the corneal transplant surgery, which typically takes one to two hours under local anesthesia.
  2. Patient is monitored closely in the immediate post-operative period for any signs of complications such as infection or rejection.
  3. Patient follows a strict regimen of eye drops and medications to prevent infection and rejection of the transplant.
  4. Patient attends regular follow-up appointments with their ophthalmologist to monitor the healing process and ensure the success of the transplant.
  5. Patient may experience fluctuations in vision and discomfort in the weeks following the surgery, but these typically improve over time.
  6. Patient may need to make lifestyle changes to protect their new cornea, such as avoiding activities that could increase the risk of injury or infection.
  7. Patient may require additional surgeries or procedures in the future to maintain the health of their transplanted cornea.

What to Ask Your Doctor

  1. What is the success rate of corneal transplants in general, and what factors can increase the risk of transplant failure?
  2. What is my specific risk of rejection or failure for this corneal transplant, and what can be done to minimize this risk?
  3. What are the potential complications or side effects of a corneal transplant, and how will they be managed if they occur?
  4. How long is the recovery process after a corneal transplant, and what kind of follow-up care will be needed?
  5. Are there any lifestyle changes or restrictions I need to be aware of after the transplant?
  6. Are there any alternative treatments or options to consider instead of a corneal transplant?
  7. What ongoing research or advancements are being made in the field of corneal transplants that could potentially benefit me in the future?
  8. Are there any support groups or resources available for patients who have undergone corneal transplants?

Reference

Authors: Armitage WJ, Goodchild C, Griffin MD, Gunn DJ, Hjortdal J, Lohan P, Murphy CC, Pleyer U, Ritter T, Tole DM, Vabres B. Journal: Transplantation. 2019 Dec;103(12):2468-2478. doi: 10.1097/TP.0000000000002938. PMID: 31765363