Finding a doctor is easy. Finding exactly the right doctor for your rare and complex condition is much more difficult. That is why so many Keratoconus Patients from all over the world travel to the California Keratoconus Center for their non-surgical Keratoconus treatment. They know they’ve found the best Keratoconus specialist for their condition.

Did you know keratoconus corneal transplants are only necessary in 15% to 20% of severe keratoconus cases? Even though that is true, many eye doctors recommend transplants for many of their patients, perhaps because they aren’t as familiar with (or do not provide) non-surgical alternatives.

The anatomy of the human eye is complex.

Anatomy of the Human Eye

The main non-surgical alternative to corneal transplant surgery for Keratoconus patients involves Scleral Contact Lenses. In fact, many Keratoconus patients will still need Scleral Lenses after their corneal transplants, bringing into question the efficacy of the transplant surgery in the first place.

Before committing to corneal transplant surgery, please learn as much as you can about the procedure, and then get a second opinion.

People facing the prospect of corneal transplant surgery have questions about the surgical procedure and its risks, recovery, and effectiveness. So, let’s get started with some answers.

What are the Different Types of Corneal Transplant Surgery?

There are three primary surgical options for corneal transplants that a surgeon uses depending upon the patient’s situation. They are:

  • Penetrating keratoplasty — complete cornea replacement
  • Endothelial keratoplasty — partial removal of diseased tissue on the back corneal layers using one of two procedures: Descemet stripping endothelial keratoplasty (DSEK) or Descemet membrane endothelial keratoplasty (DMEK)
  • Anterior lamellar keratoplasty — partial removal of diseased tissue on the front corneal layers using one of two procedures: Superficial anterior lamellar keratoplasty (SALK) or Deep anterior lamellar keratoplasty (DALK)

Many times, your ophthalmologist will plan on replacing just the back of the cornea, but almost as often, this plan needs to be changed during the procedure and the entire cornea needs to be replaced.

What Happens During a Corneal Transplant?

Corneal transplants are also known as corneal grafts or keratoplasty. These invasive procedures involve removing part or all of your damaged cornea and replacing it with healthy donor cells or an artificial cornea (keratoprosthesis).

The patient receives a local anesthetic and a sedative to manage pain and limit movement during this delicate operation. The surgeon uses a special device to keep the eye open, removes all or just the damaged parts of the cornea, implants the donor or artificial material, and uses stitches to keep the transplanted material in the proper position.

The procedure takes several hours, and you should expect to remain in the hospital or surgical facility for several hours (or longer if there are complications) to allow the surgeon to monitor the results before sending you home.

Corneal Surgery protective contact lens

Placing a contact lens on an eye after Corneal Surgery

What are the Risks of Corneal Surgery?

Like any invasive surgery, keratoconus corneal transplants carry risks. In this case, possible risks include:

  • Infection
  • Temporary swelling around the surgical site
  • Bleeding
  • Problems with the stitches
  • Retinal issues such as detachment or swelling
  • Elevated chance of cataracts forming later
  • Elevated chance of developing glaucoma from increased eye pressure
  • Rejection of the donor material, which can occur up to 20% of the time for full-thickness cornea transplants. When that happens, you will need to have the procedure done over again.

Recovering from Corneal Transplants

Your surgeon will provide you with the details of your particular corneal transplant recovery process. These postoperative requirements and restrictions may include:

  • Return visit to your surgeon in 24-48 hours
  • Wearing an eye patch for a period of time
  • Wearing protective glasses for a longer period of time
  • Stitch removal if necessary — some stitches stay in for several months and others require no removal
  • Using prescription eye drops or ointments daily, often for several months, to fight infection and reduce swelling
  • Avoiding certain activities that could risk harm to your eyes
  • Lying face up for several days after an endothelial transplant
  • Several additional follow-up visits during the first year following surgery
  • Inability to wear corrective contact lenses for up to 6 months

How Long Does It Take to Recover from My Keratoconus Corneal Transplant Surgery?

The length of the recovery depends upon the individual and the surgical procedure itself. Postoperative problems can extend the length of recovery. However, you can expect recovery from any corneal transplant to take several months, during which time you cannot wear contact lenses.

How Long Does a Corneal Transplant for Keratoconus Last?

According to an article published by the National Institutes of Health, transplants routinely last between 5 and 10 years. This means younger recipients will need additional surgeries over their lifetime.

These timeframes do not include the transplants that are rejected by the body and need to be replaced sooner. However, in some cases, corneal transplants may last much longer — up to 20 years or more.

Will I have 20/20 Vision after My Corneal Transplant?

Probably not. Corneal transplants do not generally provide 20/20 vision. The procedure does improve vision, but you’ll need additional vision correction, typically specialty contact lenses like Scleral Lenses. Also, depending on the type of corneal transplant surgery, reaching your final vision improvement takes from three months to a year.

Why do I have Cloudy Vision after My Transplant Surgery?

It takes three to twelve months for your transplants to fully heal and provide better vision. Cloudiness diminishes as your eye heals and adapts to the transplant.

How Soon can I Drive after a Corneal Transplant Procedure?

Driving can expose you to unnecessary bumps, jarring, and other movements capable of damaging the surgical site. As a result, you cannot drive on the day of the surgery. Your surgeon may approve driving after 24 hours, depending on the surgical procedure, the vision in your other eye, or other factors. Your doctor may also require you to wait longer.

How Many Corneal Transplants for Keratoconus can I Have?

You can have several transplants if your overall health and eye conditions allow.

How do I Sleep after My Corneal Transplant Surgery?

You will probably need to sleep on your back for a few days or weeks until your transplant sufficiently heals.

You must also wear a protective eye shield to prevent accidentally hitting, poking, or rubbing your eye during the night.

Other Corneal Surgeries

Corneal Transplants are not the only kind of corneal surgery. Two other corneal surgical options are available and might be appropriate depending on your diagnosis: corneal cross-linking and Intacs® corneal implants.

Corneal Cross-Linking

Corneal cross-linking (CXL) is an outpatient surgery designed to stop the progression of Keratoconus. It involves applying a riboflavin solution to the eye and activating it using ultraviolet light (UV-A). The procedure causes additional links to develop across collagen strands in the cornea, creating a stronger cornea structure that helps maintain proper shape. Surgeons typically remove the corneal epithelial layer, so the solution penetrates better into the stroma (the middle layer of the cornea).

The procedure can take as little as 30 minutes for each eye, with the procedure for each eye typically performed several weeks to a couple months apart. Learn more about Corneal Cross-Linking

It’s important to remember that CXL can stop the progression of Keratoconus, but does not reverse or cure a patient from the damage caused by Keratoconus.

Intacs® Corneal Implants

Surgeons implant these semi-circle-shaped medical devices in channels that are cut into the cornea. The implants are designed to help focus incoming light more evenly on the retina, correcting some of the focal problems resulting from Keratoconus.

However, Intacs can often cause complications, resulting in additional surgeries, removal of the Intacs, or the need for specialty contact lenses like Scleral Lenses.

What if I have Already had Corneal Transplants?

Since corneal transplant surgery rarely results in clear 20/20 vision, we routinely help patients who have had Keratoconus corneal transplants performed by other doctors with their post-surgery vision correction needs. We use the most advanced technology to measure the surface of your eyes, determine your prescription and design your scleral contact lenses. Many patients end up with 20/40, 20/30 and even 20/20 vision with scleral lenses, whether or not they have previously had corneal transplant surgery.

Are there Non-Surgical Alternatives to Keratoconus Corneal Transplants?

In our professional opinion after 30 years of experience with treating Keratoconus, surgery should always be the last option. There are too many risks and in 80-85% of keratoconus cases, the transplants aren’t necessary. In fact, transplants often provide poorer results than our advanced non-surgical solutions. And, even with corneal transplants, patients need additional vision correction.

More often than ever before, Ophthalmologists are referring their patients to the California Keratoconus Center for a second opinion before they perform Corneal Transplant Surgery. That’s because the doctors at the California Keratoconus Center have earned the reputation as the non-surgical keratoconus treatment specialists due to the industry-leading cKlear MethodTM protocol developed in our clinic.

We invite you to read about our non-surgical keratoconus treatment options, then make an appointment by calling us at 818-891-6711 or online. Either way, we look forward to helping you see comfortably and clearly, without surgery!