A cornea transplant is an operation to replace all or part of a damaged cornea. The cornea is the clear, outer layer at the front of your eye. The operation can improve your eyesight or treat other eye problems.

Why is Corneal Transplant Done?

You may need a cornea transplant if your cornea is damaged and glasses or contact lenses are no longer enough to improve your vision.

Damage to the cornea can be caused by conditions such as:

• Keratoconus, an eye condition where the cornea gradually gets thinner and changes shape.
• Fuch’s dystrophy, a condition passed down in families that makes your cornea cloudy.
• A serious eye infection.
• Problems after cataract surgery.
• An eye injury
  
  

What Happens During a Cornea Transplant?

A cornea transplant takes about 1 to 2 hours. You will usually have a local anesthetic and eye drops to make your eye numb so you do not feel any pain. The eye drops also stop your eye from working, so you will not be able to see during the operation. You may also be given a sedative to help you relax, or you may be asleep during the procedure if you have a general anesthetic.

The operation involves replacing the damaged parts of your cornea with a new cornea. The new cornea comes from a person who has passed away and donated their cornea¹⁵. The donated cornea is checked to make sure it is healthy before it is used.

The main steps are:

• The surgeon makes a small cut to remove the damaged layers of your cornea.
• A replacement piece of cornea is put in its place.
• Tiny stitches may be used to fix the new cornea in place.

Before the Operation (Pre-Operative Preparation)

Before the cornea transplant, your doctor will do a full eye checkup to see if there are any other problems that might cause issues after the surgery. They will also take measurements of your eye to find the right size of donor cornea.

Here are some things you may need to do before the operation:

• Tell your doctor about all your medicines: Let your doctor know about all the medicines, supplements, and herbs you are taking. You may need to stop taking some of them, especially blood thinners like aspirin, a few days before the surgery. Always follow your doctor’s instructions carefully.
• Get other eye problems treated: If you have any other eye problems, like an infection or swelling, your doctor will treat them first. This helps make sure the cornea transplant is successful.
• Do not eat or drink: Your doctor will tell you when to stop eating and drinking before the surgery. This is usually after midnight on the night before the operation. You may be allowed to drink a small amount of water with your regular medicines.
• Arrange for a ride home: You will not be able to drive yourself home after the surgery, so make sure a family member or friend can take you.
• Wear comfortable clothes: On the day of the surgery, wear loose, comfortable clothes. Do not wear any makeup, lotion, or jewelry.
  
  

HOTA Approval Process

For a cornea transplant to happen in Pakistan, it needs to be approved by the Human Organ Transplant Authority (HOTA). This is a government body that makes sure all organ and tissue transplants are done legally and ethically, without any buying or selling of organs.

Here is the general process:

• Donation: The new cornea comes from a person who has passed away and who pledged to donate their organs and tissues. They fill out a “Pledge Form” and carry a donor card. It is important for the donor’s family to be aware of their wishes.
• Hospital Evaluation: The hospital where the transplant will take place will check the health of the donated cornea and ensure it is safe to use.
• Human Organ Transplant Authority (HOTA) Approval: The hospital submits all the necessary paperwork to HOTA. This includes documents about the patient and the donated tissue. HOTA has an Evaluation Committee that reviews each case to make sure everything is being done according to the law. They ensure there is no illegal activity and that the donation is truly voluntary.
• Transplant: Once HOTA gives its approval, the cornea transplant can proceed. The entire process is meant to protect both the donor’s and the recipient’s rights and well-being.

After the Operation

After the operation

After the operation, a patch will be placed over your eye, which can usually be taken off the next day. You will be given steroid and antibiotic eye drops to use every day. The stitches will be left in for several months but will be gradually removed at your follow-up appointments.

Recovering from a cornea transplant

• You may need to take about 2 weeks off from work.
• Your eye should not be very painful, but you might have some swelling, redness, and discomfort for up to 2 weeks.
• Your vision will take time to get better, and you will likely still need to wear glasses or contact lenses. It can take anywhere from 6 months to 2 years for your vision to improve, depending on the type of transplant.
• You will have follow-up appointments, first in the first week, and then every few months for the next 1 to 2 years or longer.

Do’s and Don’ts

Do:

• Take painkillers like paracetamol if you need them.
• Wear the plastic eye shield you are given at night to protect your eye.
• Use your eye drops as told by the doctor. You will need to use them for a long time to reduce the chance of the transplant failing.
• You can bathe or shower as you normally would, but be careful not to get water in your eye for at least one month.

Don’ts:

• Do not rub your eye for the first few weeks.
• Do not drive until your vision is good enough and your doctor says it is okay.
• Do not play contact sports until your doctor says it is okay.
• Do not go swimming or wear eye makeup for at least one month.
  
  

Possible Problems with a Corneal Transplant

As with any operation, problems can happen. Your doctor will explain the risks to you before the procedure.

Some problems could include:

• Transplant rejection: This is when your body’s immune system attacks the new cornea. This can be treated with steroids if found quickly.
• Astigmatism: The transplant can affect the shape of your eye and your vision. You may need more surgery if glasses are not enough to improve your vision.
• Infection: An eye infection can usually be treated with antibiotics.

Call Your Care Team Right Away If:

After your cornea transplant, you get any of these signs, as they could be signs of a serious problem like transplant rejection or a detached retina:

• A red eye.
• Eye pain.
• Sensitivity to light.
• Blurred vision.
• Dots and lines (floaters) that suddenly appear or increase in number.
• Flashes of light in your vision.
• A dark “curtain” or shadow moving across your vision.

If you cannot reach your care team, ask for an urgent appointment with a doctor.