Learning that you or your offspring has keratoconus can result in anxiety regarding the potential for progressive vision loss. The possibility of becoming legally-blind is something that you may fear will become your reality in future (or the reality of your keratoconus-afflicted child). However, most people with this cornea disorder experience only nearsightedness and astigmatism. In people with severe keratoconus and resulting eye pain who are not likely to benefit from more conservative surgical interventions (or who have undergone other types of corrective surgeries that have failed), a corneal transplant may be recommended.
Described below are reasons you (or your offspring) may need a corneal transplant consequent to keratoconus, and some corneal transplant risks and post-transplant issues for consideration.
Symptoms Suggesting Need for Corneal Transplant
Progressive vision loss can occur in keratoconus-afflicted people that can result in legal-blindness. Meanwhile, corneal pain (typically consequent to progressive thinning of the abnormally-shaped cornea) is a symptom that can render wearing contact lenses impossible due to discomfort. The Cornea Research Foundation of America (CRFA) notes that corneal scarring can result due to wearing contact lenses that rest on the cornea. (The scarring occurs because the abnormal epithelial cells that are a feature of keratoconus weaken the cornea – and this makes the cornea more susceptible to injury.)
Corneal cross-linking and other minimally-invasive surgical approaches are often attempted to halt the progressive vision loss or other symptoms before a corneal transplant is recommended. Notably, keratoconus eventually leads to the need for a corneal transplant in only one out of every five keratoconus-afflicted individuals (per the CRFA).
Keratoconus-related Conditions Treated by a Corneal Transplant
The following are three of the cornea conditions that can be treated by a corneal transplant besides correction of the corneal bulge occuring in keratoconus (per the Mayo Clinic’s website):
- Thinning of the cornea;
- Clouding of the cornea;
- Corneal ulcers
Most keratoconus-afflicted people undergoing a corneal transplant experience a successful corrective surgery. Moreover – according to an article in the American Journal of Ophthalmology – sequential bilateral corneal transplant reduces the graft failure rate in the first eye receiving a donor corneal graft. Corneal transplantation is an outpatient procedure, and either local or general anesthesia is utilized for pain management during the surgery.
Preparing for the Corneal Transplantation Surgery
Similar to most outpatient surgeries, a patient undergoing this type of surgery cannot eat or drink for a specified number of hours before the surgery. This is to prevent aspiration while under anesthesia that can result in aspiration pneumonia.
According to American Academy of Ophthalmology, a person taking blood-thinning medication (e.g., Heparin) will need to discontinue that medication prior to cornea transplant surgery in order to prevent extensive bleeding. Meanwhile, a general physical exam to ensure that a corneal transplant candidate is actually healthy enough to undergo surgery is also necessary. Anyone who is ill with a bacterial or viral should postpone corneal transplantation until the infection has resolved.
Signs of Corneal Transplant Rejection
Thirty percent of corneal transplant patients experience one episode of graft rejection (according to The College of Optometrists). However, far fewer experience permanent rejection. In order to avoid permanent rejection, the following symptoms associated with donor cornea rejection require immediate attention:
- Eye pain;
- “Redness” and/or swelling in the eye;
- Experiencing increased sensitivity to light;
- Cloudy or hazy vision (i.e., experiencing progressive vision loss)
When rejection is occuring, commencement of a corticosteroid eye-drop regimen is typical. However, the risk for the transplant recipient of the prolonged use of topical corticosteroids is steroid-induced glaucoma. In that event, the glaucoma will require treatment so this disorder does not cause blindness.
Recuperating after Corneal Transplant Surgery
For a few days after surgery, most patients experience a scratchy or irritated sensation in the affected eye. The use of prescribed daily eye drops to prevent rejection is necessary. Most corneal transplant recipients can return to work within two weeks following surgery, but with certain limitations (such as refraining from heavy lifting) to protect the eye while healing from surgery.
At the Precision Keratoconus Center, we seek to aid you in understanding keratoconus treatment options to aid you in preserving your vision.