A Comprehensive Guide to Corneal Transplant in Singapore
In Singapore, corneal transplant surgery is performed using modern surgical techniques under strict safety and ethical protocols. The country benefits from a well-established eye donation and transplant infrastructure, ensuring high standards of care.
At Eye & Cornea Surgeons, our diagnostic technologies and surgical expertise are tailored to treat complex corneal conditions, ensuring our patients receive the best possible care throughout their treatment journey. For those considering a cornea transplant in Singapore, timely assessment and planning are essential.
Corneal Transplantation
A corneal transplant, also known as keratoplasty, is a surgical procedure in which a damaged or diseased cornea is replaced with healthy donor corneal tissue. The cornea is the transparent, dome-shaped front layer of the eye responsible for focusing light onto the retina.
When the cornea becomes scarred, swollen, or misshapen, it can result in significant visual impairment or even blindness. In such cases, corneal replacement surgery may be the most effective means of restoring visual function.
When Is Corneal Transplantation Necessary?
A corneal transplant may be recommended for patients experiencing various conditions that compromise corneal health and vision. This surgical procedure is most often used to restore vision to an individual with a damaged cornea and can also alleviate pain or other symptoms associated with corneal diseases.
Common indicators for a corneal transplant include:
- Keratoconus: A condition characterised by the progressive thinning and outward bulging of the cornea into a cone shape, rather than its normal dome shape.
- Corneal Scarring: Often a result of infections (such as herpes simplex virus) or injuries, leading to opacity that impairs vision.
- Fuchs' Endothelial Dystrophy: A genetic condition where cells in the innermost layer of the cornea (endothelium) do not function effectively, leading to corneal swelling and blurred vision.
- Corneal Oedema (Swelling): Persistent swelling of the cornea that significantly affects vision.
- Corneal Failure After Previous Eye Surgery: Complications from prior eye surgeries that result in damage to the cornea.
A comprehensive consultation with an ophthalmologist is essential to determine candidacy for surgery. This evaluation considers the severity of vision impairment, the underlying corneal condition, and the response to other treatments to ensure the most appropriate course of action.
Types of Corneal Transplants
There are several forms of corneal tissue transplant procedures, each suited to different conditions. A specialist ophthalmologist will determine the most suitable option after a comprehensive evaluation.
Penetrating Keratoplasty (PK)
Penetrating keratoplasty (PK), also known as a full-thickness corneal transplant, involves replacing the entire central cornea. This procedure is suitable when both the front and inner corneal layers are significantly damaged or when deep stromal scarring is present. During PK, the diseased or damaged cornea is carefully removed, and a clear donor cornea is precisely sewn into its place.
The recovery period for PK is generally longer than other types of corneal transplant, often taking a year or longer.
Deep Anterior Lamellar Keratoplasty (DALK)
Deep anterior lamellar keratoplasty (DALK) is a partial-thickness corneal transplant that replaces only the front and middle layers of the cornea, specifically preserving the patient's own innermost layer, the endothelium. This technique is particularly suitable for conditions like keratoconus, corneal scars, and stromal dystrophies, where the damage is primarily to the anterior (front) corneal layers.
By retaining the healthy endothelium, DALK significantly reduces the risk of graft rejection (1-2% vs. 15% for PK), often allowing for earlier discontinuation of medications. It also offers benefits like a potentially lower risk of astigmatism, greater long-term longevity, and a shorter recovery period.
Endothelial Keratoplasty
Endothelial keratoplasty is a specialised partial corneal transplant that treats conditions like Fuchs' endothelial dystrophy or bullous keratopathy, where the innermost corneal layer (endothelium) is damaged. This surgery replaces only the damaged endothelium with healthy donor tissue through a small incision, often requiring few or no stitches. This approach leaves most of the cornea untouched, significantly lowering the risk of graft rejection.
This approach has several types:
Descemet's Stripping Endothelial Keratoplasty (DSEK)
DSEK is a partial-thickness graft specifically designed to replace the inner endothelial layer. This technique often leads to a faster recovery for patients. With DSEK surgery, the donor tissue is slightly thicker, which can make it easier for the surgeon to transplant and position during the procedure.
Descemet Membrane Endothelial Keratoplasty (DMEK)
DMEK is a more refined version of DSEK. This method transplants only the Descemet membrane and the endothelium, offering even quicker visual restoration and a lower risk of graft rejection, typically ranging from 1-4%.
Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK)
DSAEK is an evolution of the DSEK technique, utilising automated instrumentation to enhance precision. This procedure specifically targets diseases affecting the back layer of the cornea, such as Fuchs' dystrophy.
In cases where traditional transplantation may not be suitable, such as in patients with multiple graft failures, severe chemical injuries, or autoimmune-related corneal degeneration, artificial cornea surgery (keratoprosthesis, or KPro) may be considered. This prosthetic option offers an alternative solution when donor grafts are no longer viable.
Corneal Transplantation Procedure
A corneal transplant is typically performed as an outpatient procedure under local or general anaesthesia, depending on the patient's condition and the complexity of the surgery. The duration of the operation ranges from 30 to 90 minutes.
Once anaesthesia takes effect, the surgeon carefully removes the affected portion of the cornea using specialised instruments. Donor tissue is then prepared and sutured using the necessary techniques required for the chosen type of transplant (PK, DALK, DSEK, or DMEK).
Corneal Transplantation Recovery
Recovery following corneal transplant surgery varies depending on the type of procedure performed. Visual improvement typically begins within three to six months, although full recovery may take up to 12 months. Endothelial procedures such as Descemet membrane endothelial keratoplasty (DMEK) often allow for faster healing compared to full-thickness grafts such as penetrating keratoplasty (PK).
Immediately after the procedure, patients are monitored for a short period and are usually discharged on the same day. A protective eye shield is applied, and a regimen of medications, including antibiotic and anti-inflammatory eye drops, is prescribed to support healing and prevent complications.
Possible Risks and Complications
While corneal transplantation has a high success rate, complications can occur. The good news is that most can be managed effectively with prompt intervention.
Common risks include:
- Graft Rejection: Occurs in up to 10-20%. Early signs: redness, light sensitivity, decreased vision, pain.
- Infection: Linked to poor hygiene or non-compliance with care instructions.
- Astigmatism or Vision Fluctuation: Common after PK.
- Glaucoma: May develop post-surgery due to increased intraocular pressure.
At ECS Clinic, our experienced team of corneal surgeons takes a meticulous approach to every transplant, contributing to consistently positive surgical outcomes. With appropriate care and follow-up, many patients experience substantial improvement in vision within three to six months, although complete visual recovery may take up to one year.
If you or a loved one is experiencing significant visual decline due to corneal conditions, consult our cornea surgeon to explore whether a corneal transplant in Singapore is a suitable treatment. Contact us today to schedule an appointment.
Frequently Asked Questions
How long does a corneal transplant last?
What are the signs of corneal graft rejection?
Symptoms of graft rejection include:
- Redness of the eye
- Sensitivity to light
- Decrease in vision
- Eye pain
These signs should prompt immediate medical review, as early treatment can reverse rejection in most cases.
Can both eyes be treated?
What is the waiting time for donor tissue in Singapore?
Can you go blind if a corneal transplant fails?
How much does a corneal transplant cost in Singapore?
The cost of a corneal transplant in Singapore can vary significantly based on several factors, including the complexity of the procedure, the type of surgical technique employed, and whether the treatment is received at a public or private healthcare facility. Additional factors such as surgeons' fees, post-operative care, and diagnostic tests may also influence overall expenses.
Patients are advised to consult with their healthcare provider to understand the specific breakdown of costs and to verify eligibility for MediSave claims or private insurance coverage, where applicable.