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UNDERSTANDING THE ANATOMY OF YOUR EYES
It is very helpful to have a little information about the different parts of your eye when trying to understand what really happens during your surgery.
The cornea is the clear tissue in front of the pupil and Iris. You actually see through the cornea, just as you would look through a window. Behind the pupil is the lens, which along with the Cornea, focuses the light entering the eye. The retina in the back of the eye is composed of specialized nerve cells that transmit the light impulses coming through the front of the eye to the optic nerve and then to the brain. In a healthy, normal eye, light passes through the cornea and lens, and is focused on the retina. Sharp vision requires all structures of the eye to be in good working order. Like a foggy window, loss of transparency of the cornea will contribute to reducing vision. Clouding of the cornea can be related to many factors, such as injury, infection, congenital disorders, and aging.
In a corneal transplant procedure, the central portion of your cloudy cornea is replaced with clear corneal tissue from a donor.
CORNEAL TRANSPLANT SURGERY
A corneal transplant involves removing the cloudy central portion of your cornea and replacing it with an exact duplicate ''button'' of healthy corneal tissue from a donor.
When the lens of the eye becomes cloudy, it is called a cataract. In some cases, removal of the cataract can be combined with a corneal transplant procedure. If a cataract is removed at the time Of surgery, a lens implant (which replaces your own natural lens) may be inserted. In patient who have had previous cataract Surgery and lens Implant, the lens already implanted in the eye may have to be removed or exchanged during surgery for another type of lens.
Occasionally the vitreous jelly can protrude forward toward the cornea: This is most common in patients who have had previous surgery or Injury. If the vitreous jelly has moved close to the cornea, It must be removed at the time of transplant surgery. This procedure is called a vitrectomy. The healthy donor cornea is then fixed into position by sutures that are only one/third tee thickness of a human hair.
Most commonly we use a modified form of local anesthesia for corneal transplant surgery. You are given medication intravenously which induces a twilight sleep in which you will be awake be but very calm and relaxed. Complicated or prolonged cases are evaluated individually and may require general anesthesia. If you are extremely nervous or are unable to lie on your back awake for any length of time, we may recommend general anesthesia.
DONOR CORNEAS
In 1944 the world's first eye bank was organized In New York. There are now over one hundred eye banks across the country. When a hospital or emergency room has a terminally ill patient who has designated that his/her eyes will be donated, the nearest regional eye bank coordinates the collection of the donor eyes. The donated cornea is then placed in a storage solution which can keep it healthy for several days. During this time the eye bank performs tests on the tissue to be certain that the donor did not have a disease that could be transmitted with the cornea. The eye bank then contacts surgeons who have patient most in need of a corneal transplant so plans for the surgery can be finalized. Most eye banks in the United States are tracked be a computer system that lists the availability of donor corneas across the country. We often use corneas from eye banks in other parts of the country.
Unfortunately there are many more patients who need corneal transplant than there are donors. Therefore, it could take several weeks or longer to obtain a cornea for your surgery.
The age, race, sex, or eye color of the donor do not affect the outcome of transplantation surgery as long as the cornea is otherwise healthy. (One exception would be a very young patient at who might need tissue from a young donor to assure longevity of the corneal tissue.) Likewise, it does not matter if the donor was nearsighted or farsighted.
Unlike other types of transplant, such as heart or kidney, there IS usually no need to match the blood of the corneal donor to the recipient. However, in patients who have already had several failed transplants or after certain types of corneal Infection, it may be necessary to match the donor to the recipient.
POST-OPERATIVE CARE
Hospital Stay Normally you will be discharged home the same day of surgery although in certain circumstances you may Stay overnight. This will be discussed with you.
PROTECTION OF THE EYE
One of the most important things you must do is protect the operated eye at all times! For the first few weeks after surgery, even a mild blow to the eye could cause the transplant to loosen. This might require further surgery, or even a new transplant.
During the day you may use an old pair of prescription glasses, or an Inexpensive pair of non-prescription g1asses. Alternately, you may use the metal or plastic eye shield which you received in the hospital. The shield should be taped across the eye from the center of the brow to the cheek. Protection of the eye does not have to be airtight - wind or small amounta of dust are generally not harmful to the eye. Of more concern are the seemingly insignificant traumas such as from a child's finger, a pet's paw, or the edge of a door or piece of furniture.
The eye shield should be used when you go to bed at night.
The eye must be protected at all times for at least four weeks.
After that time eye protection is no longer needed for normal activities or sleep.
The gauze pad which was over the eye in the hospital is mainly to help keep the eye closed and to absorb excess tears for the first few days after surgery. If you are not feeling an: discomfort in the eye and are having minimal tearings you do not need to use the pads. The gauze pads alone are not adequate protection for the eye! To adequately protect the eye you must use either glasses or the eye shield.
Remember..... after a corneal transplant the eye never heals with the same strength of a normal eye, even years after surgery. Therefore, if you participate in any activity where there is a possibility of direct blow to the eye (contact sports, hockey, lacrosse, tennis, racquet ball, etc.) protective eyewear must be worn.
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