Corneal graft operation

Patients undergoing a corneal graft operation are admitted to a ward the day of their operation and discharged home on the same day. If no donor cornea is available we will attempt to contact you prior to your operation or patients will return home and wait until material becomes available.

Checks such as urine tests, blood tests and sometimes an electrocardiogram (ECG) are carried out to make sure you are in good health for the general anaesthetic.

Your surgeon will carry out the operation with the help of a microscope. For a full thickness graft, a central piece of poor cornea is cut through and removed from your eye. It is replaced by clear cornea removed in the same manner from the donor eye. This is then sewn in place with very fine stitches which are removed 1-2 years later.  The operation takes about an hour, and is carried out under either general or local anaesthetic.

Post-operative care

After the operation, the operated eye only will be covered with an eye pad and protective plastic eye shield. As the anaesthetic wears off, some discomfort may be felt in and around the operated eye. If you feel any pain, ask for medicine for relief of any pain or sickness. You may resume normal activities when you feel able to do so. You will be shown how to instil eye drops safely and correctly prior to your discharge.

The day after the operation the eye pad is removed. Your sight will probably be blurred; your eye may water and be uncomfortable in bright light. You will be asked to return to the hospital in the next day or two. The nurse and your ophthalmologist will examine your eye.

Aftercare

How long will I use eye drops after the operation?

Your ophthalmologist may ask you to put in eye drops for six months or more after the operation. It is essential the eye drop treatment is continued exactly as instructed until the end of the course. This is very important because it helps prevent infection and rejection.

Is there anything else I have to do to care for my eye?

You will be given a protective plastic eye shield to wear when sleeping for about two weeks after the operation. You should avoid any risk of a direct blow on your operated eye. You may find that you are sensitive to light and a pair of plain dark glasses, which can be bought cheaply at any chemist, should help. Ask your ophthalmologist when you may return to work or pursue sports especially swimming.

How long will I be attending hospital after the operation?

Uncomplicated cases can expect to attend about seven times in the first year after surgery and once or twice in the second year. Patients may be discharged from follow-up after the stitches have been removed, usually 1-2 years after the operation. Stitches are removed at outpatient clinic examinations. However, even after discharge you should be aware that rejection episodes may occur which require urgent treatment.

Rejection/complications

There is a danger of rejection of the transplant because the body's immune defence system recognises the donor cornea as foreign and tries to damage the "foreign body". It is very important to look out for signs that your corneal graft might be undergoing rejection. If you experience one or more of the following, see a doctor or go to your eye casualty department immediately:

• decrease in sight, 
• redness of the eye, or 
• pain.

Rejections occur most often in the first year after the operation, following a change of treatment, after removal of stitches, or as a result of eye infection or injury. However, rejection can occur at any time after a corneal graft, even years later after your discharge from outpatients. It is therefore important to be aware of the danger signs.

What should I do if I think there is a problem with my corneal graft?

Providing you attend for treatment promptly, rejection reactions can usually be controlled. It is your responsibility to come to the casualty department of Moorfields or your nearest eye department whenever you feel there is a problem with your grafted eye - even many years later after successful surgery.

Failure to obtain the correct treatment early can result in permanent loss of sight and the need for a repeat transplant which carries a higher risk of failure than the first.

If you experience any decrease in sight, pain or redness in the grafted eye, remember that this may represent a rejection and should be seen within 24 hours in an eye department.

Other complications following a corneal graft

Serious complications are uncommon following graft surgery. However, it is a major eye operation and like all operations may be accompanied by complications including haemorrhage (bleeding in the eye) and damage to other parts of the eye. The period after the operation can be complicated by infection, rejection, glaucoma, and cataract formation. Therefore, it is essential that you keep your follow-up appointments at Moorfields. If any symptoms suddenly develop you must attend as an emergency patient at an eye casualty department immediately.