Cornea transplant surgery (keratoplasty) replaces damaged corneal tissue with healthy donor tissue. The cornea is the eye’s clear, dome-shaped outer layer that focuses light, making it fundamental to clear vision. This procedure is commonly performed to restore sight or alleviate discomfort caused by conditions that cloud or distort the cornea, such as keratoconus, Fuchs’ dystrophy, or scarring from injury or infection. A cornea transplant offers a path toward improved vision for individuals whose sight is impaired by these corneal diseases.
Anesthesia and Sensation During Surgery
The actual cornea transplant procedure is not painful because it is performed using effective anesthesia. Most patients receive local anesthesia, often delivered via an injection around the eye, which completely numbs the area. This local block is frequently paired with intravenous sedation (sometimes called “twilight anesthesia”) to keep the patient relaxed and comfortable throughout the operation.
This combination eliminates sharp pain, though patients may still feel sensations of pressure or movement. Full-thickness transplants (Penetrating Keratoplasty) may require general anesthesia, depending on the patient’s health and the surgeon’s preference. The anesthetic protocol ensures the patient feels no pain during the 60 to 90 minutes the surgery typically lasts.
Managing Discomfort Immediately After Surgery
While the surgery is painless, patients should expect a period of discomfort in the immediate hours and days following the procedure. This is typically described as a gritty feeling, irritation, burning, or a mild ache, similar to having a foreign body in the eye. This post-operative discomfort is a normal part of the healing process as the eye adjusts to the new tissue.
Mild symptoms are managed using over-the-counter pain relievers, such as acetaminophen or ibuprofen. Surgeons also prescribe a strict regimen of eye drops, including steroids to control inflammation and prevent rejection, and antibiotics to guard against infection. These drops reduce swelling and irritation, minimizing discomfort. Temporary side effects like light sensitivity and increased tearing are also common during this acute recovery phase.
What Happens on the Day of the Procedure
For most patients, the cornea transplant is an outpatient procedure, meaning they generally go home the same day. Upon arrival at the surgical center, the pre-operative process involves meeting with the surgical and anesthesia teams. Patients are prepared for surgery by receiving medicated eye drops and often an intravenous line for sedation to manage anxiety.
The surgery typically takes between one and two hours, depending on the type of transplant. Afterward, the eye is usually covered with a protective patch or shield to prevent injury. The patient is monitored in a recovery area as the effects of the sedation wear off. Before discharge, the patient receives detailed instructions on medication use, activity restrictions, and the scheduling of their follow-up appointment for the next day.
Milestones and Expectations for Long-Term Recovery
The recovery from a cornea transplant is a long-term process requiring patience and adherence to the prescribed care plan. Immediately following surgery, patients must avoid activities that strain the eye, such as heavy lifting or bending past the waist, for several weeks. Patients must protect the eye by wearing an eye shield, especially at night, and must not rub the eye under any circumstances.
Vision Improvement and Stitches
Vision improvement is gradual, and final visual acuity can take many months to achieve, sometimes up to a year or more, particularly with full-thickness grafts. For full-thickness transplants, the tiny stitches holding the new tissue in place may be removed slowly over many months to stabilize the cornea’s shape. Follow-up appointments are frequent initially, then decrease over time. Long-term use of steroid eye drops, sometimes for a year or longer, is often required to prevent the body from rejecting the donor tissue.
Recognizing Complications
Patients must remain vigilant for signs that require immediate medical attention. These include sudden, severe eye pain, the eye becoming significantly red, increased sensitivity to light, or a sudden decrease in vision. These symptoms can indicate a complication, such as graft rejection, which is a risk that continues for years after the transplant. Early detection and treatment of rejection with medication can often save the transplanted cornea.