Corneal transplant

INTERACTIVE: Corneal transplant

August 18, 1999
Web posted at: 11:45 a.m. EDT (1545 GMT)

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Stories abound about patients whose laser surgery went awry -- and then they needed a corneal transplant, in which a healthy donor cornea replaces the diseased or injured cornea. The need for a corneal transplant after laser refractive surgery is not common, says Dr. Lee Klein, a Fort Lauderdale, Florida, corneal and refractive specialist.

Mark Larson, executive director of The Eye Bank of Wisconsin in Madison, calls the need for a transplant after LASIK and other refractive surgeries "extremely rare,'' adding that there are no published numbers to his knowledge.

"When it does happen, (the transplant) is usually successful,'' he says.

Those who have had refractive surgery, however, are banned by medical standards from being cornea donors after death, Larson says, although they are welcome to donate their corneas for research. The eye banks, he says are erring on the side of caution; a cornea that has had refractive surgery may be too thin or otherwise deficient to withstand successful transplantation.

Most often, a corneal transplant is performed to treat problems other than refractive surgery complications -- such as keratoconus, in which the cornea assumes a cone shape and major changes in vision occur, often requiring frequent prescription changes in eyeglasses or contact lenses.

Such was the case with Scott Mager, 37, a Florida lawyer and motivational speaker who had resorted to "piggyback'' contact lenses (wearing both rigid and soft lenses) to correct the -20 diopters of nearsightedness caused by the keratoconus, says Klein.

In the procedure, a corneal "button'' is punched out from the central part of the donor cornea; up to 80 percent of the host cornea is removed, and the donor button is sutured into place. In the case of Mager, who had a corneal transplant earlier this year, "it took 14 stitches,'' he says.

Success rates vary from about 50 to 90 percent, depending on the condition. For Mager, the surgery was successful. Three months later, Mager sees 20/30 with the use of a soft contact lens of -8 diopters, Klein says.

"It would be a perfect world if we ended up requiring zero power in the lens" after a corneal transplant. But the point of the surgery is not to correct vision problems per se but the underlying disease.

Rejection of the graft as well as infection, nearsightedness and other problems are possible.

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