Corneal Transplantation at the Confraternität Private Hospital
Prof. Dr. Christian Skorpik
Ophthalmology and optometry
For which diseases is cornea transplantation recommended?
On the one hand with impaired vision as a result of clouding of the cornea, on the other hand also as an acute operation in case of corneal ulcers, infections and injuries. Clouding of the of the cornea can be caused by various diseases as well as of injuries (e.g. chemical burns, burns, trauma).
Which surgical techniques are available?
On the one hand, there is the complete transplantation (penetrating keratoplasty - PKP), in which the tissue is punched and replaced in its full thickness, but individually depending on the need with a certain diameter, mostly in a round shape.
On the other hand, only certain layers of the cornea can be transplanted, i.e. replaced by healthy donor corneal tissue. Depending on the type of disease or localization of the changes, scars or opacities, only the anterior corneal tissue (anterior keratoplasty: Deep Anterior Lamellar Keratoplasty - DALK) or the posterior corneal tissue such as Descemt's membrane and endothelium (Descemet Stripping Enothelial Keratoplasty - DSEK) is replaced or, as a more modern technique, Descemet Membrane Endothelial Keratoplasty - DMEK.
What exactly is done during these operations?
In penetrating keratoplasty (PKP), the diseased or clouded tissue is cut out circularly with a round punch and the same is done with the healthy donor corneal tissue. The piece of tissue is exchanged and sutured in place in a circular manner. The sutures stay a little longer than a year because the corneal tissue heals very slowly.
In the anterior lamellar keratoplasty, the recipient and donor eyes are cut to a certain depth and then the tissue is replaced. In most cases, the fabric is also sutured in, but the sutures usually remain for a shorter period than with PKP.
In posterior lamellar keratoplasty, the most common diagnosis is "Fuchs’s corneal endothelial dystrophy" or corneal damage with opacity after cataract surgery. During the operation, the patient's Descemet membrane with the diseased endothelium, which is responsible for clarity and transparency in a healthy state, is removed via a small incision (similar to a cataract operation). A Descemet membrane with a healthy endothelium with the largest possible diameter is obtained from a donor cornea in order to transplant as many healthy cells as possible.
What are the risks?
With every transplant there is the risk of an immunologically induced rejection reaction, which must be recognized and treated, as otherwise irreversible renewed corneal opacity can occur. Eyes that have already been operated on, eyes with strong blood vessel sprouting and eyes with recurrent diseases such as herpes corneae are particularly at risk.
A cornea transplant can be repeated any number of times.
What are the contraindications?
In principle, there are no contraindications. Patients must be cooperative and follow-up examinations must be observed. Corneal scars after burns and injuries generally have a very poor chance of recovery. In these cases, surgery is not recommended.
How do patients have to prepare for the operation?
No special preparations are required before the operation. Blood-thinning medication should be discontinued or therapy changed if possible.
What has to be considered after the operation?
Patients are mobilized immediately after the operation. They either get eye protection contact lenses or a bandage for a few days. Local eye therapy must be given for a few months or more. Sports with a risk of injury should be avoided. In the first postoperative week you should lift not more thana few kilos. After that, a normal lifestyle is usually possible.
How long does the rehabilitation take?
The length of the rehabilitation period varies depending on the surgical technique. With penetrating keratoplasty and anterior lamellar keratoplasty, it lasts until the suture is removed, i.e. up to 14 months postoperatively. With endothelial keratoplasty, eyesight increases significantly a few days after the operation and the rehabilitation period is relatively short. Usually vision is significantly better 2-3 weeks postoperatively than preoperatively. There should be no air travel for 5-7 days after the operation. However, the final optimal vision is only achieved after a few months.
The Confraternität Private Hospital offers an optimal medical infrastructure for these operations. Appointments are possible at relatively short notice.
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