Cornea Transplant Surgery Procedure

Introduction

The cornea plays a vital role in our ability to see clearly. It’s the transparent, dome-shaped surface that covers the front of the eye, acting like a window that focuses light onto the retina. When the cornea becomes damaged due to disease, injury, or infection, it can result in blurred vision, glare, and even blindness. In such cases, a cornea transplant surgery also known as keratoplasty is often recommended to restore sight.

A cornea transplant involves replacing part or all of a damaged cornea with healthy tissue from a donor. It’s one of the most commonly performed and successful transplant procedures in the world. With the help of modern medical advancements, corneal transplants today are safer, more precise, and more tailored to individual patient needs. Whether the damage is superficial or deep, surgeons can now customize the procedure to replace only the affected layer of the cornea.

Understanding the step-by-step c process of this surgery not only helps in demystifying the experience but also prepares patients both physically and mentally. Let’s explore the major stages of a cornea transplant surgery procedure.

Cornea Transplant Surgery Procedure

1. Pre-operative Evaluation and Preparation :- Before the surgery is scheduled, a comprehensive eye examination is conducted. The ophthalmologist assesses the extent of corneal damage using imaging tests such as corneal topography, pachymetry, and slit-lamp examination. The goal is to determine the exact cause of vision loss whether it’s due to keratoconus, scarring, Fuchs’ dystrophy, or infection. Blood tests and overall health evaluations are also carried out to ensure the patient is fit for surgery. If both eyes are affected, typically only one eye is treated at a time. The doctor also discusses the type of cornea transplant best suited to the patient’s condition full-thickness (PK), partial-thickness (DALK, DSEK, or DMEK), or artificial cornea. Instructions are provided on medications to take or stop, along with advice about fasting before surgery.

2. Donor Cornea Matching and Selection :- Cornea transplant surgery depends on the availability of donor tissue. Eye banks collect corneas from recently deceased donors, screen them for diseases such as HIV and hepatitis, and preserve them until surgery. The selected donor tissue must meet quality standards and be free of infection. Matching a donor cornea does not require blood type matching as in other organ transplants. However, quality, clarity, and endothelial cell count are crucial parameters. The donor cornea is delivered to the hospital sterile and ready for use. In some cases, patients may be placed on a waiting list until suitable tissue becomes available.

3. Administering Anesthesia :- On the day of surgery, the patient is prepped and brought into the operating room. The procedure is typically performed under local anesthesia with sedation. This numbs the eye and surrounding area while keeping the patient relaxed. In some complex or pediatric cases, general anesthesia may be used. The eye is then cleaned and draped with sterile covers. A speculum is placed to hold the eyelids open. Throughout the procedure, the patient is monitored carefully to ensure comfort and stability.

4. Removing the Damaged Corneal Tissue :- Depending on the type of keratoplasty chosen, the surgeon removes the affected portion of the cornea. In Penetrating Keratoplasty (PK), a circular section of the full corneal thickness is removed using a trephine, which works like a tiny cookie cutter. For partial-thickness procedures like DALK or DMEK, only specific layers are delicately peeled away, leaving the healthy layers intact. This part of the surgery is highly technical and demands precision. Any remaining irregular or damaged tissue is carefully smoothed to ensure a perfect fit for the donor graft.

5. Placing and Suturing the Donor Cornea :-The healthy donor tissue, cut to match the recipient area, is gently placed over the eye. It is carefully aligned to ensure that the curvature and position are correct. In full-thickness transplants, the graft is secured using ultra-fine sutures, often with 16 to 24 individual stitches around the circumference. In advanced lamellar transplants like DMEK, the tissue may naturally adhere without the need for stitches, relying instead on a bubble of air or gas to hold it in place until it attaches securely. The surgeon ensures there is no fluid leakage, that the wound is watertight, and that the graft is stable. Microscopic instruments and high-magnification visuals are used for accuracy.

6. Post-Surgery Monitoring and Recovery Room :- Once the procedure is completed, the patient is moved to a recovery area. The eye is patched and protected with a shield. Vital signs are monitored until the effects of anesthesia wear off. Patients are usually discharged on the same day, with instructions to avoid rubbing the eye, heavy lifting, and sleeping on the operated side. Medications such as antibiotic and steroid eye drops are prescribed to prevent infection and suppress the immune response, reducing the risk of graft rejection. Pain relievers may also be given to manage discomfort in the first few days.

7. Follow-Up Appointments :- The first follow-up appointment usually happens the day after surgery. Regular visits are scheduled over the next few weeks and months to monitor healing, intraocular pressure, and signs of rejection. Vision may remain blurry at first but improves gradually over time.  Sutures, if used, may be removed after several months depending on healing and visual outcomes. Patients are advised to wear protective eyewear and avoid any trauma to the eye. Long-term care includes continued use of eye drops and regular eye exams. Most patients are able to return to daily activities within a few weeks, though full visual recovery can take months depending on the type of transplant.

Conclusion

Cornea transplant surgery is a powerful procedure that restores vision and improves quality of life for people affected by corneal diseases or injuries. While the process may seem complex, each step from evaluation to post-op care is carefully designed to maximize success and safety. With personalized surgical options now available, patients receive treatment tailored to the specific layers of the cornea that are affected.

Understanding the procedure in detail helps reduce anxiety and empowers patients to actively participate in their recovery journey. With modern techniques, skilled surgeons, and quality donor tissue, cornea transplants today have high success rates and can be truly life-changing.