Complications after Corneal Transplant Surgery

The cornea in your eye is a dome-shaped, transparent surface that helps you focus on objects in your vision. Corneal damage and disorders are not just the 4th leading cause of blindness across the globe; corneal blindness is also quite the menace with a list of other problems as well. An unhealthy cornea causes vision problems by distorting the light rays entering your eyes, thus blurring the image forming on the retina. The best-known treatment to cure this is corneal transplant surgery.

What happens in Corneal Transplant Surgery?

In simple words, the damaged or diseased cornea is replaced with a healthy cornea tissue of a donor in corneal transplant surgery. Also known as Keratoplasty, it is a process of grafting that is complex and rare, due to the lack of cornea donors.
There are majorly two different types of keratoplasties done: Penetrating and Endothelial. Penetrating is a full thickness cornea transplant, whereas, Endothelial is a back layer cornea transplant.

When do you need a Corneal Transplant?

A cornea specialist usually suggests corneal transplant as an option for when their vision cannot be restored with either prescription glasses or contact lenses. Another scenario for choosing a transplant is when any medication does not lessen conditions like pain and swelling. Situations in which the capabilities of the cornea are hindered include the following:

• Scarring of the cornea due to infections
• Inheriting conditions like Fuch’s dystrophy
• Excessive swelling or inflammation of the cornea.
• Complications from previous cataract surgery.
• Irregularly shaped cornea or thinning of the cornea.
• Burns and other injuries to the cornea.
• Eye diseases that affect the cornea like keratoconus.
• Trichiasis that causes corneal scarring due to eyelashes growing inwards.
• Rare cases of graft rejection in previous corneal transplant surgery.

Aftermath of Keratoplasty

Although most corneal transplants are successful, there have been cases where the patients suffer some side-effects and complications after the surgery. There are some risks involved in such a delicate procedure. An eye doctor identifies most of them beforehand and only suggests this surgical method if either the problem has been resolved or it is not likely to cause trouble. Other times, issues arise right after the surgery and even need emergency treatment. And further, some problem grows gradually, taking their time to be spotted in later check-ups.

Graft Rejection

This is one of the major problems that cause complications after the surgery and cannot be predicted. Here, the patient’s immune system recognizes the foreign graft and tries to reject its insertion in the body. This condition is quite common, yet only about 5% of corneal graft transplants fail because of it. While some symptoms of rejections occur in every 5th transplant, severe rejection is not common. The symptoms may start as soon as a few weeks after the surgery or later in a few months.

Graft rejection symptoms can be treated if you start steroid eye drops medication course as soon as possible. The main identifying symptoms for graft rejection after a transplant surgery include:

• Pain in the eyes
• Red eyes
• Light sensitivity
• Blurred or foggy vision

To tackle graft rejection, you can have second transplant surgery. The procedure usually solves the problem, but it also involves higher risks. The chances of graft rejection increase with the number of transplants you have.

Other Problems

Aside from graft rejection, there are quite a few other complications and side-effects that can happen after getting keratoplasty. Some of the most prominent ones are:
• Odd curvature of the cornea causing astigmatism

• Inflammation in the middle layer of the eye called Uveitis.

• The relapse of the original disease that caused corneal damage or blindness.

• Glaucoma, where trapped fluid builds pressure from inside the eye.

• Unsuccessful healing of wounds from the transplant surgery.

• Infection in the surgery wounds.

• When Retinal Detachment occurs after the retina pulls away from blood vessels.

When the patient is at higher risk of human tissue transplant failure, artificial corneas are used as the replacement. Some level of astigmatism and myopia can be even after a successful keratoplasty, because the new corneal graft may not always be of the perfect curvature for your eye. Considering this margin for error and side-effects, corneal transplant hospitals are still researching for more permanent and successful methods of corneal transplant.