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.

Francesca Cassa, Brescia (Montichiari)

Votazione: Eccellente
Many years ago, herpes virus left  me with a corneal scar. Over time, I alternated periods of "quiet" to relapses of various seriousness (included a corneal ulcer).

My eyesight has gradually worsened to about 1/10.
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Most of the eye doctors I have consulted advised me against perforating corneal transplantation.

Then, I read on the internet about lamellar transplant technique. The first consultation (4 years ago at another medical center) left me with some concerns. Following the deterioration and difficulty in performing some simple tasks with one eye (e.g. drive), I tried again.

After having found the name of Dr. Badalà, I booked a visit. After preliminary tests I described the situation, he reassured me (I am a quite anxious person!). He proposed me the surgery, explaining the advantages, risks and prospects and I decided to undergo surgery, which was performed under general anesthesia.

The operation was successful, without any pain or postoperative problems (related to anesthesia).

After a few hours I already got up, the same day they removed my blindfold and I had already gained 1/10, how exciting!

The next day I was discharged, and I returned home by train.

I recovered my daily life immediately, with a few days of rest and appropriate care.

Now (six months after surgery) I am rigorously following therapy ,but I have no specific difficulties and obstacles (only some discomfort related to the sun and summer heat).

The eye is slowly improving, even someone asks me what has happened since the color is back like the other (before the opacity was so obvious that the two eyes seemed different color!) and at each check-up visual acuity earns some points (after six months I see 7/10 versus 1/10 in advance).

I thank Dr. Badalà for guiding me to this decision with the serenity which me and my family needed, and how he continues to guide me in the post-transplant course.