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After the Corneal Transplant Operation
 

After the Surgery

   If you are an outpatient, you may go home after a short stay in the recovery area.  You should plan to have someone else drive you home.  An examination at the doctor's office will be scheduled for the following day.

   You will need to:

  • Use the eye drops as prescribed;
  • Be careful not to rub or press on your eye;
  • Use over-the-counter pain medicine, if necessary;
  • Continue normal daily activities except exercise;
  • Ask your doctor when you can begin driving;
  • Wear eyeglasses or an eye shield as advised by your doctor.

   Dr. Cano will decide when to remove the stitches, depending upon the health of the eye and rate of healing.  Usually, it will be several months, at least, before stitches are removed, or up to a year.

  Caring for your corneal transplant after surgery partly depends on you.  You and Dr. Cano must work together well, and you must follow strictly his instructions on how to care for your precious new graft.  You probably will need to use eye drops for many months, and Dr. Cano will need to see you regularly in the office.  There will be certain restrictions on your activities in the early period after your surgery.

Chances of Success

   For an eye that has no problems other than a corneal dystrophy, the chances of having a clear graft are better than 90%.  But to be successful, you must carefully follow the difficult schedules for using your medications and seeing Dr. Cano.  Failure to follow the prescribed schedules could greatly decrease the chances of successful surgery.

What complications can occur?

Corneal transplants are rejected 5% to 30% of the time.  The rejected cornea clouds and vision deteriorates.

   Most rejections, if treated promptly, can be stopped with minimal injury.  Warning signs of rejection are:

  • Persistent discomfort;
  • Light sensitivity;
  • Redness;
  • Change in vision.

   Any of these symptoms should be reported to Dr. Cano promptly.  Here are some problems that could delay or prevent return of useful sight in your operated eye:

Primary graft failure - This is a cloudiness of the cornea that can occur the first week or two after surgery.  It is caused by a fault in the donor cornea or damage to it during surgery.  The only treatment is to do another transplant with a different donor cornea.  Fortunately, this problem is rare.
 
Graft rejection - This is an "allergic" reaction of the body against the transplant.  It can occur any time two weeks or more after surgery.  There is a good chance that this can be successfully treated if you act immediately. 

The Four danger signs of corneal graft rejection are:

A)  Increasingly Red Eye
B)  Decreasing Vision
C)  Increased Pain that Lasts for Several Hours
D)  Increased Sensitivity to Light, Lasting for Several Hours

If any of these occur and last for more than 6 hours, you should immediately call Dr. Cano.  These signs are:

1)  Red eye - It is normal for your eye to be red in the first weeks after surgery.  If at any time your eye begins to get more red, then this is cause for concern, and you should call Dr. Cano.  You can easily check the redness of your eye by looking into a mirror and pulling down the lower lid.  Look carefully at the white part of the eye, especially in the area next to the cornea.  You might even check your eye periodically even if you're not having any problems, so you will know what it looks like when it's normal.

2)  Decreased vision - Even though it can take weeks or months to get good vision after you've had your transplant, your vision probably will be gradually improving after your surgery.  Pick an object in your household that has some pattern or detail to it and get in the habit of covering your good eye and looking at this object every day.  In this way you can tell how your vision is doing.  If your vision seems to be getting worse, then there could be a problem with your eye, and then you should call Dr. Cano.

3)  Pain - It's normal to have occasional small twinges of pain in your eye.  But if your eye develops constant pain for several hours, call Dr. Cano.
 
4)  Increased sensitivity - Bright lights might seem irritating to your eye after surgery.  This too should slowly get better.  If you notice that your eye is becoming more sensitive to light so that you feel like squinting or covering it, then again you should call Dr. Cano.

Wound separation - This is a small gap in the area where the edge of the graft is sewn into the eye. There might be no symptoms at all or only a dull ache. It might be treated with a light patch, or soft contact lens, or it may require a trip back to the operating room so that additional suturing of the graft can be done.

 

A wound separation is a small gap where the donor cornea is sewn into the eye.  Depending on the size, it might be treated with a soft contact lens (A), an eye patch (B), or insertion of additional sutures in the graft (C).
 


Astigmatism - This occurs when the grafted cornea has the oblong shape of the surface of a football rather than the round shape of a basketball's surface.  All grafts have some astigmatism, and usually this can be corrected with glasses or a contact lens.  If this astigmatism is severe, a special kind of surgery can often correct it.
 

A)  A cornea without astigmatism is equally curved in all directions, like the surface of a basketball.

B)  A cornea with astigmatism has an oblong surface like that of a football; its surface curvature is steeper in one direction and flatter in another.

 

Loose suture - Occasionally during the healing process, a suture can loosen and cause a foreign body feeling, especially when you blink.  The loose suture can easily an painlessly be removed in the office. 

 

 

 

 

 

 

 

A corneal dystrophy in the graft - Certain corneal dystrophies can recur in the graft just as they occurred in your original cornea. Fortunately, this ~.s not common; when it does occur, it usually takes many years to develop. Another corneal transplant can be done, if necessary, to restore useful vision for you; like your first graft, this new graft has an excellent chance of giving you many years of good vision.

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Other possible complications include:

  • Infection;
  • Bleeding;
  • Swelling or detachment of the retina;
  • Glaucoma.

   All of these complications can be treated.

   A corneal transplant can be repeated, usually with good results, but the overall rejection rates for repeated transplants are higher than for the first time around.

   Irregular curvature of the transplanted cornea (astigmatism) may slow the return of vision but can also be treated.  Vision may continue to improve up to a year after surgery.

   Even if the surgery is successful, any other eye conditions, such as macular degeneration (aging of the retina), glaucoma, or diabetic damage, may limit vision after surgery.  Even with such problems, corneal transplantation may still be worthwhile.

   A successful corneal transplant requires care and attention on the part of both patient and physician.  However, no other surgery has so much to offer when the cornea is deeply scarred or swollen.  The vast majority of people who undergo corneal transplants are happy with their improved vision.

   Of course, corneal transplant surgery would not be possible without the hundreds of thousands of generous donors and their families who have donated corneal tissue so that others may see.


Why are regular medical eye examinations important for everyone?

   Eye disease can occur at any age.  Many eye diseases do not cause symptoms until the disease has done damage.  Since most blindness is preventable if diagnosed and treated early, regular medical examinations by an ophthalmologist are very important.  If  you are experience any optical difficulties, or just need a routine eye exam,  please make an appointment to see Dr. Cano.


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