When Is a Cornea Transplant Needed?
The cornea is the transparent, dome-shaped outermost layer of the eye. It plays a critical role in focusing incoming light onto the retina, enabling clear vision. When the cornea is damaged or diseased, it can lead to significant visual impairment or even blindness. In cases where medical therapy cannot restore corneal function, a corneal transplant may become necessary.
Indications for a Corneal Transplant
The primary goal of a corneal transplant is to replace damaged corneal tissue with healthy donor tissue. This aims to restore corneal transparency, improve visual acuity, and alleviate pain associated with certain corneal conditions.
Corneal transplantation may be recommended to treat corneal tissue damage due to:
1. Keratoconus
Keratoconus is a progressive, non-inflammatory thinning disorder of the cornea that causes it to assume a conical shape. This distortion leads to irregular astigmatism and significant visual deterioration. When contact lenses or corneal cross-linking are no longer effective, transplantation is often the only option.
Selective lamellar techniques such as deep anterior lamellar keratoplasty (DALK) are typically preferred to preserve healthy endothelium and reduce the risk of graft rejection.
2. Corneal Scarring
Infections such as bacterial, fungal, or viral keratitis can cause dense corneal opacities that permanently impair vision. Herpes simplex virus is a common culprit in Singapore, particularly among patients with a history of recurrent epithelial keratitis. When scarring affects the central visual axis and is not amenable to laser correction, penetrating keratoplasty (PK) or lamellar keratoplasty may be required to restore clarity.
3. Corneal Dystrophies
These are genetic conditions, such as Fuchs' endothelial dystrophy, that primarily affect the inner layer of the cornea, causing swelling and vision distortion. When vision worsens despite conservative management, selective endothelial transplants (e.g., DMEK, DSAEK) are often indicated and prove particularly effective in such cases.
4. Graft Failure
In some patients with prior transplants, the donor tissue may gradually fail due to rejection, infection, trauma, or underlying host factors, necessitating a repeat procedure. The surgical approach for a re-transplant will depend on the extent of tissue loss, previous surgeries, and overall ocular health.
5. Bullous Keratopathy
This is a condition where the cornea's endothelial cells are lost or damaged, resulting in swelling and painful blisters. This is a common complication after cataract surgery, particularly in elderly patients, often requiring surgical intervention. Procedures like DSAEK or DMEK offer significant symptomatic relief and functional improvement for those affected.
Eligibility for a Corneal Transplant
Persistent blurry vision, corneal swelling, thinning or bulging, visual distortion, pain, and reduced vision unresponsive to medication or lenses are all common signs that may indicate the need for a corneal transplant. These symptoms often suggest a deterioration in your corneal structure or function.
However, not everyone is a suitable candidate. Patients with severe eye diseases (like uncontrolled glaucoma or retinal degeneration), systemic autoimmune disorders, or a history of poor post-operative compliance may not be eligible.
Eligibility is determined based on:
- Type and severity of corneal disease
- Overall eye health
- Presence of systemic comorbidities (e.g., autoimmune diseases)
- Patient’s ability to adhere to postoperative care
A full ophthalmological assessment is always required to determine suitability and the best course of action for your vision.
ECS Clinic for Corneal Transplantation
If you are experiencing symptoms like persistent blurry vision or ocular discomfort or have a known history of corneal disease, early evaluation by a qualified ophthalmologist is essential. This crucial step helps to prevent long-term visual impairment.
At Eye & Cornea Surgeons, patients undergo comprehensive assessments using modern diagnostic imaging and personalised treatment planning. This is crucial for various complex corneal disorders, including those that may require corneal transplant surgery.
Explore your options for restoring vision and eye health. Consult our specialist for an accurate diagnosis and treatment plan. Contact us today to make an appointment.