Corneal Transplant: rejection and other risks

Corneal transplant rejection

Major risks after corneal transplant are related to rejection. There is always a risk of rejection after corneal transplant: it is usually higher right after surgery and lowers over time.

Symptoms of rejection can be as light as a simple redness of the eye: even this should never be underestimated in patients that have undergone corneal transplant, especially if such symptoms persist for a few days. In these cases the best thing to do is to consult an ophthalmologist. Other symptoms could be photophobia (intolerance to visual perception of light) or vision obfuscation.

Rejection treatment have to start as soon as possible in order to have more chances of success; it is usually based on cortisone eye drops. After surgery, it is important to avoid any eye trauma, at least for the first months.

Surgery lasts about 60-90 minutes: patients leave the operating room with bandages that are removed the following day. Post-op duration after this surgery may vary depending on the kind of transplant (traditional, lamellar or artificial like the Boston Keratoprosthesis). In case of traditional corneal transplant, post-op lasts a few months.

In case of anterior lamellar corneal tranplant (DALK), post-op lasts for a few weeks; same goes for the endothelial corneal transplant (DSAEK). The Boston Keratoprosthesis post-op takes up only a few days.

What are the risks for corneal transplant?

Major risks for this tranplant belong to two categories: the ones that may occur during surgery and the ones that may occur after.

Intraoperative risks can be pretty serious in case of traditional corneal transplant, where the whole cornea is subtituted: the eye remains open with no protection during the process.

In this very phase, it may occur a serious complication called expulsive hemorrhage; anyway it is a rare complication that may happen in case of a full-depth corneal transplant. There is no report of this complication in case of lamellar corneal transplant.

Risks after corneal transplant surgery are mainly related to rejection. There is always a risk of rejection in case of corneal transplant but it is important to remember that this kind of transplant holds the higher success rate of every other organ transplant.

With lamellar transplant like DALK (in depth anterior lamellar keratoplastic) or DSAEK (endothelial corneal transplant), there is a lower risk of rejection because the portion of transplanted cornea is smaller.
Rejection treatment is based upon cortisone eye drops that may result in collateral effects such as cataract or glaucoma; with lamellar trasplant, rejection treatment is quicker.

Piero Banna, Catania

Votazione: Eccellente
I underwent DMEK (an endothelian cornel transplant) in my right eye over a year ago. The corneal transplant was performed by Dr. Badalà.
My vision was very bad, 20/200 in the affected eye and it was bothering the visio... Keep on reading this reviewn I had with my better eye, making it very difficult to use the two eyes together, specifically when driving.
I trust Dr. Badalà because of US training and said: “I’m at the last shore, even if the surgery doesn’t go well, this eye is only giving me problems”
All eye examination before and after the operation were performed in the excellent Eye center located in Catania.
The corneal transplant with the very new technique DMEK (Descemet Membrane Endothelial Keratoplasty) was carried out in Milan in a private hospital, accredited with the National Healthcare,with state of the art equipment and was totally free of charge for me.
The surgery was under general anesthesia without complications. The only real problem, which was extensively explained by Dr. Badalà, is that I had to stay flat in bed for the first day with my head facing the ceiling. This is because the new endothelial cells transplanted are kept in place by a small air bubble. I was allowed to move every half an hour and from the next day I was allowed to go back to a normal life.
The time in the hospital - one night - was fast and warmed up by a very kind nursing team and frequent encounters with the doctor, who was always answering my questions, showing confidence and humanity.
No patching and fast progressive visual rehabilitation surprised me. Two months post-op. visual acuity was 20/40, similar to my better eye. Six months after visual acuity is 20/25 much better and clear than my “older” good eye.
When I went to buy a new pair of glasses my German optician, well-known in Catania, said: “I can’t believe it, it’s a miracle! Who’s the eye surgeon that made this new eye? Tell him he made a good job!”
I’m convinced that corneal transplant surgery is complex and requires high technology and a lot of experience, when a surgery like this seems simple and routinary, that means that the eye surgeon is really good.
Thank you Doctor Badalà, I’m starting to think seriously about getting a corneal transplant in the other eye.