Corneal Transplant at the Döbling Private Hospital
Corneal diseases are the fourth most common cause of blindness worldwide. Many of these diseases can be cured with a corneal transplant. Today keratoplasty (corneal transplantation) is the most common form of tissue transplantation in humans. Due to significant advances in corneal surgery in recent years - both in surgical techniques and in the preparation of the transplanted tissue - the success rates of these procedures by experienced specialists are very high, and the risks and side effects have been significantly reduced.
Assoc.-Prof. Priv.-Doz. Dr. Gerald Schmidinger
Specialist in Ophthalmology and Optometry
Prof. Schmidinger, what are the most common indications for a cornea transplant?
Today, the most common reasons for transplantation are Fuchs' dystrophy and other changes in the inner layers of the cornea. These mostly congenital changes usually cause symptoms only after the age of 60. They lead to blurred vision, increased sensitivity to light and, later, to pain in the eye.
Another common reason for a corneal transplant is keratoconus in which the cornea of the eye thins and bulges outward in a cone shape, which is associated with fluctuating and decreasing vision. Injuries, chemical burns or infections can also lead to scarring and cause irreparable damage. In all of these cases, transplants can be performed using what is known as “penetrating keratoplasty”.
How is this operation done?
In a classic corneal transplant, all layers of the cornea are replaced (full transplant / penetrating keratoplasty). This technique is therefore basically suitable for all clinical pictures. In this surgical technique, the diseased tissue is removed from the eye using microsurgical instruments and replaced with a suitable piece of tissue from a donor organ. The new tissue is then secured in the recipient eye with stitches. These stitches usually remain in place for one year.
There are surgical techniques in which not the entire cornea is replaced, but only individual layers. In which cases are these techniques used?
Yes, for example the DMEK method (Descemet Membrane Endothelial Keratoplasty). This is the most successful new technique for partial transplantation of the inner layer of the cornea. This surgical technique has significant advantages over a full transplant and has revolutionized corneal surgery. The rehabilitation time is significantly shorter and the achievable visual acuity is better than with full transplants. A transplantation of all layers of the cornea is therefore avoided if possible.
The DMEK technique is used for endothelial diseases (endothelium = inner tissue layer of the cornea) such as Fuchs dystrophy or bullous keratopathy.
How does this method work?
In contrast to a full transplant, only the innermost layer of the cornea (Descemet's membrane with endothelial cells) is transplanted. The layer in question is only 0.002 millimeters thick. In a first step, this membrane is obtained from the donor cornea and prepared for transplantation. The diseased layer is removed from the patient through an incision of approximately 2millimeters at the edge of the cornea, then the transplant is inserted into the eye and fixed to the recipient eye with an air bubble. After the operation, a special position (supine position) is necessary for approximately 24 hours so that the transplant adheres well to the recipient eye.
How is anesthesia carried out? How long does the stay in the clinic last?
During DMEK surgery, anesthesia can be applied locally with eye drops, as in cataract surgery. For full transplants, general anesthesia is recommended to reduce the risk of intraoperative bleeding. Patients can usually leave the hospital after a few days.
What role does prevention and early detection play? Which examinations should be carried out regularly?
Many corneal diseases can only be diagnosed in their early stages using special diagnostic equipment. If there is a family history, it is advisable to undergo these examinations. Since corneal diseases can also occur spontaneously, general checks by ophthalmologists are recommended, especially if symptoms occur.
Where are the transplants obtained from and how are they prepared?
The extraction and production of transplants are subject to strict legal requirements throughout Europe. Transplants for donors are obtained from officially certified tissue banks. Before transplants can be used for a recipient, they undergo a variety of tests. If all quality criteria are met, the transplants are delivered to the hospital under controlled conditions. These legal requirements guarantee full traceability and maximum safety for patients.
What are the risks associated with corneal transplants? What are the success rates?
General complications after eye surgery such as infections, bleeding, increase in eye pressure and retinal complications can also occur with corneal surgery. Tissue rejection reactions are rare with corneal transplants, but cannot be ruled out. After corneal transplants, eye drops must be used for about a year to avoid local inflammatory reactions. Anti-rejection medication, as is the case with other organ transplants, is not necessary.
With DMEK surgery, 100% visual acuity can be achieved provided that there are no other eye diseases. Visual acuity is typically good just a few weeks after the operation. After total transplants, eyes achieve an average visual acuity of 60%. Visual defects are corrected with glasses or contact lenses. Transplant survival depends on the initial diagnosis. If the initial situation is favorable, the transplant can still be fully functional after 20 years.
What advantage does treatment in the Döbling Private Hospital offer to the patients?
Patients receive advice and therapy recommendations tailored to their individual problems. Preparatory examinations for procedures under anesthesia can be carried out directly in coordination with the anesthesia team in-house. The operation itself is carried out by a qualified specialist with many years of experience in corneal surgery. The high number of cases and routine ensure maximum quality of results. The Döbling Private Hospital also offers hotel comfort and professional patient management.
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