The cornea, the clear and transparent outer layer of the eye, is important for transmitting light and enabling vision. However, any opacity in the cornea can lead to severe visual impairment or blindness. In India, corneal opacities are the second leading cause of blindness in people aged 50 years and above, and the primary cause for younger patients. About 1.2 million people are affected by it corneal blindnessThe demand for cornea transplant has increased manifold. While an estimated 100,000 transplants are needed annually, only 25,000 to 30,000 procedures are performed due to an acute shortage of donor corneas. However, there are many myths about cornea transplants. We contacted Dr Gulpalli Nageswara Rao, Founder- LV Prasad Eye Institute, Hyderabad, who debunks the myths and lays out the facts on corneal transplantation.

Cornea Transplant ⁠Myths vs. Facts

Myth: The entire eye is transplanted

fact: Only the cornea is transplanted. The cornea is the clear outer layer at the front of the eye that helps focus light. The sclera, or the white part of the eye, can also be donated. There is no distortion of the body when the cornea is donated because a lens is placed to cover the area of ​​the cornea.

fact: Cornea donation should only be made after death and ideally should be retrieved. Within 6 – 8 hours after death is ideal, however, this can be extended to 12 – 24 hours if the body is kept in an air-conditioned environment. Corneas can be obtained/donated from home, funeral home, hospice, or hospital. The process of cornea retrieval takes hardly 15 minutes. The cornea is then preserved in a special medium and stored at regular refrigerator temperatures. These corneas last for up to 4 days, but the sooner they are used the better. There is also an alternative form of protection that lasts for 10 days.

fact: No, it is possible to donate cornea even if a person has poor vision. Corneal tissue is obtained from deceased people of all ages. Corneas are not obtained only if donors have a history of eye diseases that affect the cornea, or certain infectious diseases, such as HIV, hepatitis B and C, and syphilis, preventing the transmission of diseases from donor to recipient. To stop. Donors with certain medical conditions, such as autoimmune diseases, cancers that can metastasize to the eyes, or systemic infections, will be excluded.

fact: There are no blood vessels in the cornea. Therefore, most cancer patients can also donate their corneas. Only in cases where the cancer has metastasized into the eye will the cornea not be used for transplantation. It will be used for research or training purposes.

Fact: Donating cornea does not cause any deformity in the body. The process of cornea recovery hardly takes 15-20 minutes. These can be obtained from the home of the deceased, the funeral site or the hospital, wherever the body lies.

When is a cornea transplant required?

Dr. Rao explains that a corneal transplant is typically recommended when the cornea (the clear, dome-shaped surface at the front of the eye) has become damaged or diseased in such a way that vision is severely impaired. And is not treatable by any other means. Some eye conditions that may require a corneal transplant include:

1. Keratoconus: A progressive condition where the cornea thins and bulges into a cone shape, distorting vision. In severe cases, if other treatments, such as rigid contact lenses or corneal cross-linking, are not effective, a corneal transplant may be necessary to restore vision.

2. Corneal Scarring or Clouding: Trauma, infection, or other injuries to the cornea can cause lesions or clouding that interfere with vision. Common causes include injury, herpes simplex keratitis, viral infection, or fungal infection.

3. Fuchs Endothelial Dystrophy: This genetic condition affects the innermost layer of the cornea, causing fluid to build up and swell, which can blur or distort vision. Cornea transplants can help replace damaged cells.

4. Corneal Edema (Swelling): Edema can occur in conditions such as Fuchs dystrophy or after cataract surgery, where corneal endothelial cells fail to pump fluid properly. Persistent inflammation that causes vision loss may require implants.

5. Corneal Ulcers and Infections: Severe, recurrent corneal ulcers or infections, often from bacteria, fungi or viruses, can cause scarring and vision loss. If the lesion is extensive, a transplant may be necessary to restore clarity.

6. Chemical Burn or Trauma: If the eye is damaged due to a chemical burn, blunt trauma or other injury, it can cause permanent damage to the cornea that can only be repaired by a transplant.

7. Previous failed corneal transplant: In cases where a previous cornea transplant has failed due to rejection or other complications, re-transplantation (re-grafting) may be required.

The type of transplant procedure can vary, including full-thickness implants (penetrating keratoplasty) and partial-thickness implants (such as DSAEK or DMEK) that replace only the damaged layers. The choice of procedure depends on the specific condition affecting the cornea.

What are the risks and complications of corneal transplant surgery?

Dr. Rao explains that corneal transplant surgery, although often successful, has some risks and complications, like any other transplant surgery.

-Graft rejection occurs when the body’s immune system attacks the transplanted cornea. This is one of the most common complications, with symptoms such as redness, sensitivity to light, vision changes, and eye pain.

– Rejection symptoms often appear within the first year but may appear years later. The risk of rejection varies with the type of implant, with full-thickness implants having a higher rejection rate than partial-thickness procedures such as DMEK.

– Infection after surgery can affect the surface or deeper layers of the eye. Infection can cause swelling, pain, and discharge and may damage the graft.

– Infertility and proper post-operative care can reduce this risk, but it remains a serious potential complication.

-Corneal transplant surgery can increase intraocular pressure (IOP), potentially leading to glaucoma, a condition that damages the optic nerve and can cause vision loss.

– Regular monitoring of IOP is necessary after surgery, as medication or even surgery may be required if glaucoma is not controlled through medication.

– Cornea transplants can sometimes cause irregular astigmatism, where the shape of the cornea changes unevenly, causing blurry or distorted vision.

-This may require corrective lenses, and in some cases may require additional surgery to correct.

– The stitches used to hold the implant in place may cause problems such as infection, irritation, or loosening, which may affect the position or healing of the graft.

– Sometimes stitches may need to be removed or replaced earlier than planned if complications arise.

6. Swelling or edema: (Primary graft failure)

– If endothelial cells (inner layer) do not function properly the cornea may become inflamed. Persistent inflammation can affect vision and, in severe cases, require additional treatment or even another implant.

– Some patients may experience a delay in treatment due to factors such as age, immune response or pre-existing conditions. Delaying treatment increases the risk of infection and other complications.

– Some conditions, such as herpes simplex keratitis or dystrophy, may recur in the transplanted cornea, potentially leading to graft failure.

9. Infection after operation

– This is a rare but serious infection of the inside of the eye, which can cause severe inflammation and damage, potentially leading to vision loss. It requires prompt medical attention and aggressive treatment.

“Anti-rejection and anti-inflammatory medications, and usually antibiotics in the form of eye drops, are prescribed after surgery to reduce the risk of rejection and infection. Regular follow-up with the eye surgeon is essential for early detection of any problems and prompt treatment,” he said.

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