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Penetrating keratoplasty involves transplanting the entire cornea and is indicated when the entire thickness of the cornea is affected.
Benefits of penetrating keratoplasty
Improved vision. Approximately 75% of transplant patients have enough vision to drive, although they often need glasses or contact lenses, and, in some cases, further surgery to improve the quality of their eyesight.
Risks of penetrating keratoplasty
Rare but serious complications
Infection that can affect the eyesight (1 in 1,000).
Severe bleeding that causes loss of vision.
Severe inflammation or other causes of vision loss.
Vision loss. Cornea transplants can cause vision loss due to:
Cornea transplant rejection. One in six patients may reject the transplant at some time in the first few years after surgery. This often occurs because the patient stops taking the anti-rejection medication without advice from their doctor. However, rejection remains a possibility throughout the patient's life due to transplant failure or ageing, which will once again lead to reduced vision. This occurs in one in 10 transplants conducted due to keratoconus, in the first 10 years.
Glaucoma. This complication can usually be controlled by applying drops to lower the intraocular pressure, but it may occasionally require surgery.
Cataracts. These can be operated on by inserting an intraocular lens.
Surgery: cornea transplant or penetrating keratoplasty
Generally, the operation is performed under local anaesthetic and lasts approximately an hour. The procedure consists of removing an 8 mm circular section (button) from the centre of the damaged cornea and replacing it with an 8.5 mm button. This is held in place with tiny stitches that are neither visible nor noticeable.
After the operation, the extracted cornea is examined under a microscope in the microbiology and/or pathology lab.
Usually, the patient is discharged the same day. The surgeon follows up on the procedure the next day, and then a week later. From that point, the patient must have regular check-ups. If they work, it is advised that they take a two-week sick leave.
After the operation, the patient has to use anti-rejection eye drops for at least a year and, in some cases, forever. The stitches can be taken out six months after the operation, although, in general, they are not completely removed until a year has passed.