What is a Cornea Transplant?

A corneal transplant, also known as keratoplasty or corneal grafting, is a surgical procedure to replace a damaged or diseased cornea with healthy corneal tissue from a deceased donor. The cornea is the clear, dome-shaped front surface of your eye that plays a crucial role in focusing light. When the cornea becomes cloudy, scarred, or misshapen, vision can be significantly impaired. A corneal transplant aims to restore clear vision, reduce pain, and improve the overall appearance of the eye. In India, corneal transplantation has become increasingly accessible due to advancements in surgical techniques, the presence of skilled ophthalmologists, and a well-established eye donation network. This procedure offers hope and improved quality of life for individuals suffering from various corneal conditions.

Key Facts:

• Corneal transplants use tissue from deceased donors.
• The procedure can significantly improve vision and reduce pain.
• India has a growing network of eye banks facilitating transplants.
• Success rates are generally high, but complications can occur.

Why is a Cornea Transplant Performed?

A corneal transplant is typically recommended when the cornea is damaged or diseased to the point where it significantly impairs vision or causes persistent pain. Here are some of the main conditions that may necessitate a corneal transplant:

• Keratoconus: A progressive condition where the cornea thins and bulges outward into a cone shape, causing distorted vision.
• Fuchs' Dystrophy: A hereditary condition causing the cells in the inner layer of the cornea (endothelium) to gradually deteriorate, leading to corneal swelling and blurred vision.
• Corneal Scarring: Scarring of the cornea due to trauma, infection (such as herpes simplex keratitis), or previous eye surgery.
• Corneal Ulcers: Severe infections of the cornea that can cause significant tissue damage.
• Chemical Burns and Trauma: Extensive injury to the cornea from exposure to chemicals or physical trauma.
• Bullous Keratopathy: A condition in which fluid-filled blisters form on the surface of the cornea, causing pain and blurred vision.

Doctors generally recommend a corneal transplant when:

• Vision is significantly impaired and cannot be corrected with glasses or contact lenses.
• Pain is persistent and unresponsive to other treatments.
• The corneal condition is progressively worsening.
• The overall health of the eye is good enough to support a successful transplant.

Preparation for a Cornea Transplant

Proper preparation is crucial for a successful corneal transplant. Here are the essential steps:

• Comprehensive Eye Examination: Your ophthalmologist will conduct a thorough examination of your eyes to assess the extent of corneal damage and determine your suitability for a transplant.
• Medical Evaluation: You'll undergo a general medical evaluation to ensure you're healthy enough for surgery. This may include blood tests and an ECG.
• Discussion of Risks and Benefits: Your doctor will discuss the potential risks and benefits of the surgery, as well as alternative treatment options.
• Medication Review: Inform your doctor about all medications you're taking, including prescription drugs, over-the-counter medications, and herbal supplements. You may need to stop taking certain medications, such as blood thinners, before surgery.
• Pre-operative Eye Drops: You may be prescribed antibiotic eye drops to use in the days leading up to the surgery to reduce the risk of infection.
• Arrange Transportation: Arrange for someone to drive you home after the surgery, as your vision will be blurry.

India-Specific Tips:

• Fasting: Your doctor will provide specific instructions regarding fasting before surgery. Typically, you'll need to avoid eating or drinking anything for at least 6-8 hours before the procedure.
• Documents: Carry all relevant medical records, including previous eye examination reports, medication lists, and insurance documents. Aadhar card is important for identification.
• PCPNDT (Pre-Conception and Pre-Natal Diagnostic Techniques Act): While not directly related to corneal transplants, be aware of the general regulations regarding sex determination in India. This is unrelated to your eye surgery but a general awareness point.
• Accommodation: If you are traveling from another city, arrange for accommodation near the hospital for a few days after the surgery.
• Diet: Discuss dietary restrictions with your doctor or a dietician. Usually, no specific changes are required, but maintaining a healthy diet is always beneficial.

What to Expect:

• You'll likely feel anxious before the surgery. Talk to your doctor or a counselor if you're feeling overwhelmed.
• Expect to spend several hours at the hospital or surgical center on the day of the procedure.
• Your eye will be patched after surgery.
• You'll need to follow your doctor's instructions carefully after surgery to ensure proper healing.

The Cornea Transplant Procedure

The corneal transplant procedure typically takes 1-2 hours, depending on the type of transplant performed. Here's a concise step-by-step overview:

• Anesthesia: The procedure is usually performed under local anesthesia with sedation, although general anesthesia may be used in some cases, particularly for children.
• Preparation of the Eye: The eye is cleaned with an antiseptic solution, and an eyelid speculum is used to keep the eyelids open.
• Removal of Damaged Cornea: The surgeon uses specialized instruments to carefully remove the damaged or diseased portion of the cornea.
• Placement of Donor Cornea: The donor cornea, which has been carefully screened and prepared by an eye bank, is then positioned in the opening.
• Suturing: The donor cornea is secured in place with very fine sutures. The sutures are carefully placed to ensure a proper fit and minimize astigmatism.
• Post-operative Care: Antibiotic and steroid eye drops are administered to prevent infection and reduce inflammation. The eye is then patched.

Types of Corneal Transplants:

• Penetrating Keratoplasty (PK): The entire thickness of the cornea is replaced.
• Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK): Only the inner layer of the cornea (endothelium) is replaced.
• Descemet's Membrane Endothelial Keratoplasty (DMEK): Only the Descemet's membrane and endothelium are transplanted. This is the thinnest possible graft.
• Deep Anterior Lamellar Keratoplasty (DALK): The anterior layers of the cornea are replaced, while the endothelium is preserved.
• Artificial Cornea Transplant (Keratoprosthesis): A synthetic cornea is used when donor tissue is not suitable.

Duration, Comfort Level:

The surgery typically takes 1-2 hours. With local anesthesia, you may feel some pressure or discomfort, but you shouldn't feel any pain. With general anesthesia, you'll be asleep throughout the procedure.

What Happens During the Test:

There is no "test" during the procedure. It is a surgical intervention to replace damaged tissue with healthy donor tissue.

Understanding Results

The recovery process after a corneal transplant can take several months to a year. Here's what to expect:

• Initial Recovery: Your vision will likely be blurry for the first few weeks after surgery. You'll need to wear an eye patch and use prescribed eye drops to prevent infection and reduce inflammation.
• Follow-up Appointments: Regular follow-up appointments with your ophthalmologist are crucial to monitor healing and detect any complications early.
• Vision Improvement: Vision gradually improves over time as the eye heals. It may take up to a year to achieve optimal vision.
• Vision Correction: After the cornea has healed, you may need glasses or contact lenses to fine-tune your vision. In some cases, laser vision correction may be an option.

What Results Mean:

• Successful Transplant: A successful transplant results in improved vision and reduced pain.
• Rejection: If the body rejects the donor cornea, vision may worsen, and the eye may become red, painful, and sensitive to light. Rejection can often be treated with medication.
• Complications: Other potential complications include infection, glaucoma, astigmatism, and cataract.

Next Steps:

• Continue to follow your doctor's instructions carefully.
• Attend all scheduled follow-up appointments.
• Report any changes in vision or discomfort to your doctor immediately.

Costs in India

The cost of a corneal transplant in India varies depending on several factors, including the hospital, the surgeon's experience, and the type of transplant performed.

• Price Range: Generally, the cost ranges from ₹40,000 to ₹1,50,000 per eye. Laser-assisted corneal transplant costs range from ₹1,00,000 to ₹1,30,000.
• Tier-1 Cities (Mumbai, Delhi, Bangalore): Expect to pay towards the higher end of the range, potentially ₹80,000 - ₹1,50,000.
• Tier-2 Cities (Pune, Jaipur, Lucknow): Costs may be slightly lower, ranging from ₹40,000 - ₹1,20,000.

Government vs. Private Hospitals:

• Government Hospitals: Government and charitable hospitals often offer lower pricing or subsidized rates, sometimes as low as ₹20,000, especially for economically disadvantaged patients. Waiting lists may be longer.
• Private Hospitals: Private hospitals generally charge more but may offer shorter waiting times and more personalized care.

Insurance Tips:

• Check with your health insurance provider to see if corneal transplants are covered. Many insurance policies cover at least a portion of the costs.
• Understand the terms and conditions of your insurance policy, including any deductibles or co-pays.
• Obtain pre-authorization from your insurance provider before the surgery.

How Ayu Helps

Ayu can help you manage your medical records related to your corneal transplant. You can:

• Store your reports digitally, including pre-operative assessments, surgical reports, and follow-up visit summaries.
• Track your progress over time by comparing your vision test results and other relevant data.
• Share your medical information securely with your doctors and other healthcare providers via a QR code.

FAQ

Q: How long does a corneal transplant last?

A: A successful corneal transplant can last for many years, even a lifetime. However, some grafts may eventually fail and require replacement.

Q: What are the signs of corneal transplant rejection?

A: Early signs of rejection include redness, sensitivity to light, pain, and sudden blurring of vision. If you experience any of these symptoms, contact your doctor immediately.

Q: Can I wear contact lenses after a corneal transplant?

A: You may be able to wear contact lenses after the cornea has healed, but it's important to consult with your doctor. Special contact lenses may be needed to correct irregular astigmatism.

Q: How long will I be out of work after a corneal transplant?

A: The amount of time you'll need to take off from work depends on the type of transplant you had and the nature of your job. Most people need to take at least a few weeks off.

Q: Will I need to take medication after a corneal transplant?

A: Yes, you'll need to use antibiotic and steroid eye drops for several months after surgery to prevent infection and reduce inflammation. You may also need to take oral medications.

Q: How do I find a qualified corneal transplant surgeon in India?

A: Ask your ophthalmologist for a referral to a corneal specialist. You can also search online directories of ophthalmologists and read reviews from other patients. Look for surgeons with extensive experience in corneal transplantation and a good track record.

Q: What if I can't afford a corneal transplant?

A: Explore options such as government hospitals offering subsidized care, charitable organizations that provide financial assistance for medical procedures, and crowdfunding platforms to raise funds for your surgery. Discuss your financial concerns with your doctor, as they may be able to suggest resources or payment plans.

Q: How can I become an eye donor in India?

A: Pledging to donate your eyes is a selfless act that can restore sight to someone in need. You can register as an eye donor with an eye bank in your area. Talk to your family about your decision and ensure they are aware of your wishes. After death, your family can contact the eye bank to facilitate the donation process.