Cornea Transplant: Procedure, Cost, Success & Recovery

A cornea transplant is a surgery to replace a damaged cornea with healthy donor corneal tissue. Depending on the nature and severity of the patient’s condition, the procedure can involve replacing the entire cornea or a part of it. 

The types of cornea transplant approaches are as follows: 

1. Penetrating Keratoplasty: This is a full-thickness corneal transplant in which the entire damaged cornea is removed and replaced. It is used when all the layers of the cornea are opaque. 

2. Endothelial Keratoplasty: It replaces the inner layer of the cornea with healthy donor tissue. The procedure is recommended for endothelial diseases like Fuchs’ dystrophy. 

3. Anterior Lamellar Keratoplasty: The surgery involves replacing the outermost corneal layers. It is ideal for conditions like keratoconus or scarring that affects only the outer layers.

4. Keratoprosthesis: In cases where traditional transplantation is not feasible due to severe damage, an artificial cornea may be implanted to restore vision.

Anatomy and Physiology of the Cornea

The cornea is the transparent, dome-shaped front layer of the eye. It is responsible for refracting (bending) light entering the eye, focusing it onto the retina to form clear images. 

The cornea has five layers, which are as follows: 

1. Epithelium: This is the outermost layer that acts as a protective barrier against foreign substances and absorbs oxygen and nutrients.

2. Bowman’s Layer: A strong layer made of collagen that provides structure and shape to the cornea. 

3. Stroma: The thickest layer that gives the cornea its structure and transparency.

4. Descemet’s Membrane: It is a thin, strong layer that acts as a barrier against infection.

5. Endothelium: The innermost layer maintains corneal clarity by removing excess fluid from the stroma.

A cornea transplant can be recommended for several diseases that cause significant damage or vision impairment. The following are some key conditions that may be treated with this surgery: 

1. Keratoconus: In this progressive condition, the cornea thins and bulges into a cone shape. It leads to distorted vision.

2. Fuchs’ Dystrophy: It is a genetic disorder that affects the corneal endothelium, leading to fluid buildup, swelling, and eventual vision loss.

3. Corneal Scarring: This can result from injury, infection, or inflammation, significantly reducing vision. 

4. Corneal Ulcers: Severe infections can cause corneal ulcers or abscesses, affecting eyesight. 

5. Previous Corneal Surgery Complications: Failed or rejected cornea grafts from previous transplants or complications from other eye surgeries may require another transplant.

Ideal patients for a cornea transplant include those with significant vision impairment due to corneal damage that cannot be corrected with other treatments. The procedure restores vision, reduces eye pain, and treats severe damage or infection. 

It also relieves other symptoms associated with corneal diseases, including: 

1. Sensitivity to light 

2. Gritty eyes 

3. Watery eyes 

4. Redness in the eyes 

5. Discharge from the eyes

Cornea transplant surgery is performed under general (the patient is unconscious) or local anaesthesia (the area to be treated is numbed). The procedure is completed within two hours. The exact steps of the operation can vary depending on its type:

1. Penetrating Keratoplasty: This is the oldest and most common technique, which involves the following:

   1. A small circular blade removes the entire centre of the damaged cornea.

   2. The same-shaped tissue of cornea tissue is placed in this opening. 

   3. The surgeon places sutures to hold the donor cornea in place. 

2. Endothelial Keratoplasty: It can be of two types, which include Descemet stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK). The procedure steps include: 

   1. The surgeon removes the endothelium and the Descemet membrane from the back layers of the cornea.

   2. They use donor tissue to replace the removed tissue. 

   3. An air bubble is used to keep the donor cornea in place.

3. Anterior Lamellar Keratoplasty: It can also be performed using two techniques, which are as follows:

   1. In superficial anterior lamellar keratoplasty (SALK), only the front layers of the cornea are removed. The healthy stroma and endothelium are left intact. 

   2. In deep anterior lamellar keratoplasty (DALK), the front layers are removed along with the stroma. 

   3. Healthy donated corneal tissue replaces these parts of the cornea.

Note: The choice of transplant procedure depends on the specific condition affecting the patient’s cornea and the surgeon’s recommendation.

Before undergoing a cornea transplant, patients are guided through essential preparations to ensure an effective procedure. This preparatory phase is crucial for minimising potential complications and optimising the success of the transplant.

Before Cornea Transplant 

At the initial visit, the ophthalmologist explains the procedure and provides specific guidelines for preparations. Once the patient is clear for the surgery, patients wait for a donor cornea to become available. One can expect the following before a cornea transplant: 

On the Day of Cornea Transplant 

Patients should arrange for someone to drive them home after the procedure. Once they reach the hospital, the following is what usually takes place: 

Mild redness, irritation, and sensitivity to light are common for the first four days after the procedure. The doctor provides instructions to manage this discomfort and ensure a successful recovery. 

In Hospital Recovery 

Patients can often return home on the same day of the surgery. Before discharge, they are moved to a recovery room, where the nursing staff monitors their vitals. The doctor prescribes pain medications to manage any discomfort. 

At-home Recovery 

The recovery duration after a cornea transplant can differ depending on the type of procedure. 

Restoration of complete vision after a full-thickness transplant takes about one year. However, after an endothelial corneal transplant, good vision may be achieved within three months. 

During this period, patients can expect the following: 

1. Take prescribed antibiotics and anti-inflammatory eye drops to prevent infection and reduce swelling. 

2. Over-the-counter or prescribed pain relievers can help manage pain, irritation, and light sensitivity. 

3. Place an eye patch over the operated eye for one to four days. 

4. Wear glasses or other protective eyewear to protect the eyes from accidental rubbing or injury. 

5. Patients should lie on their back after surgery for endothelial surgery to help the tissue stay in place. 

6. Do not engage in activities like contact sports and swimming until the doctor approves. 

Follow-up Appointment

The first follow-up appointment is scheduled one to two days after the procedure. The doctor removes the eye patch during this visit and monitors the healing process. Depending on the type of surgery, sutures may need to be removed gradually over several months as the eye heals.

With modern techniques, the surgery has become a reliable treatment for many corneal diseases. The cornea transplant success rate is about 95%. The multiple benefits of this procedure are as follows: 

1. Restores Corneal Clarity: The transplant replaces a damaged cornea with a clear donor cornea, allowing light to enter the eye without obstruction.

2. Selective Layer Replacement: Advanced procedures like DSEK or DMEK target only specific layers, leaving healthy layers intact. 

3. Customisable Approach: Different types of corneal transplants (full or partial thickness) allow surgeons to tailor the procedure to address each patient’s unique condition.

4. Minimally Invasive: Modern techniques like endothelial keratoplasty have made the procedure less invasive. This results in a shorter recovery (about three months) and reduced discomfort.

"In my 25 years of experience as an ophthalmologist, I've seen incredible advancements in corneal transplant surgery. This procedure has become a highly reliable treatment, restoring clarity and increasing eyesight for many people. Innovations like selective layer replacement and minimally invasive procedures have not only improved surgery outcomes but also decreased recovery times, giving patients hope and comfort."

- Dr. Jaideep Dhama

Ophthalmologist

Although cornea transplant surgery is generally safe and successful, there is still a minor possibility of serious complications. One of the major risks is graft rejection, which occurs in about 10% of cases. Other complications of the procedure may include the following: 

1. Infection inside the eye or in the cornea

2. Glaucoma (elevated eye pressure) 

3. Problems with the sutures holding the graft in place 

4. Bleeding 

5. Detachment of retina 

6. Detached cornea transplant 

7. Leakage of fluid from the cornea 

When to call an ophthalmologist? 

After a cornea transplant, patients must monitor their eye health closely. They should contact their ophthalmologist if they experience any of the following symptoms of cornea rejection:

1. Eye pain 

2. Redness in the eye

3. Vision loss 

4. Sensitivity to light 

It is also important to seek medical attention for signs of infection, such as fever and eye drainage. 

Delaying a cornea transplant can lead to several complications that may further impair vision or overall eye health. These risks include: 

1. Progression of Vision Loss: Conditions like keratoconus, scarring, or corneal dystrophies continue to deteriorate without treatment. This can worsen eyesight. 

2. Increased Risk of Infection: Severe corneal damage may leave the eye more vulnerable to infections, further damaging vision and requiring immediate medical attention.

3. Reduced Quality of Life: Vision impairment from untreated corneal conditions can negatively impact daily activities like reading, driving, and working. 

Cost of Cornea Transplant 

The cornea transplant cost in India can vary significantly from one individual to another based on several factors. Generally, the price ranges between  ₹ 90,000 and ₹ 1,70,000. The average expense of the procedure is ₹ 1,10,000. 

Note: The figures mentioned above are estimates. Please talk to HexaHealth experts for accurate pricing information. 

Factors that affect the expenditure of cornea transplants include: 

1. Type of Transplant Procedure: Different types of cornea transplants (full-thickness vs partial) require varying surgical expertise and equipment, affecting the overall cost.

2. Surgeon’s Experience: Ophthalmologists with advanced skills or strong reputations in performing cornea transplants may charge higher fees.

3. Type of Hospital: Private hospitals generally offer better amenities and more comfort than government centres. This makes the former more expensive. 

4. Geographic Location: The expense of medical procedures can vary by area due to differences in the cost of living and local healthcare economics. 

5. Insurance: The extent of health insurance coverage can impact a patient’s out-of-pocket costs.

A cornea transplant restores vision and significantly improves the quality of life for corneal damage patients. By replacing the diseased cornea with a healthy donor graft, the surgery provides a clear path for light to enter the eye. With the appropriate medical care and follow-up, a successful transplant can help patients regain their independence.

At HexaHealth, we are dedicated to guiding patients before and after cornea transplant surgery by providing comprehensive support. Our network of skilled ophthalmologists offers expert surgical intervention and careful postoperative care. We provide the highest quality care to help individuals achieve the best possible outcomes.

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