Corneal transplant surgery. Brought to you in association with EIDO Healthcare and endorsed by the Royal College of Surgeons England.

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1 Corneal transplant surgery Brought to you in association with EIDO Healthcare and endorsed by the Royal College of Surgeons England. Discovery has made every effort to ensure that we obtained the information in this brochure from a reputable source. We have adapted the content to reflect the South African market or healthcare environment. You should not only depend on the information we have provided when you make any decisions about your treatment. The information is meant to act only as a guide to the treatment you are considering having. Please discuss any questions you may have about your treatment with your treating healthcare professional. Discovery Health (Pty) Ltd; registration number 1997/013480/07, an authorised financial services provider, administrator of medical schemes.

2 What is the cornea? Your eye has a number of layers. The cornea is the transparent (clear), dome-shaped outer layer in front of the black pupil and coloured iris (see figure 1). Light passes through the cornea into your eye. It protects your eye and helps to focus the light coming in. Sometimes the cornea can become diseased, causing it to become less clear. This affects your vision. Cornea Lens Iris (coloured) Figure 1 Cross-section of the eye Retina Optic nerve Your surgeon will assess you and tell you if corneal transplant surgery is suitable for you. However, it is your decision to go ahead with the operation or not. About this document We understand this can be a stressful time as you deal with different emotions and sometimes have questions after seeing your surgeon. This document will give you a basic understanding about your operation. We tell you about the things you can do to help make the operation a success. It is also important to remember to tell your surgeon about any medicine you are on so he or she can manage this, if necessary. It will also tell you about what to expect after the operation while in hospital and in the long term. Your surgeon remains the best person to speak to about any questions or concerns you may have about the operation. How does the cornea become diseased? There are many causes for the cornea becoming diseased. Three common causes need surgery. Keratoconus A condition where the cornea becomes cone-shaped, causing blurred vision. Endothelial decompensation A condition that causes the cornea to become swollen and cloudy. This may happen after cataract surgery or because of an ageing process called Fuchs endothelial dystrophy. Scarring The cornea can become scarred if you have a serious infection or injury that causes inflammation. What are the benefits of surgery? Your vision should improve. Are there any alternatives to a corneal transplant? Different types of glasses and contact lenses may help. If you have endothelial decompensation, eye drops may be helpful. Copyright 2016 Page 1 of 4

3 All these measures become less effective as the disease gets worse. What will happen if I decide not to have the operation? If your cornea is already diseased and scarred, your vision will not improve without surgery. Depending on your condition, your vision may stay the same or it may get worse. Your eye may become painful and be at an increased risk of infection. What does the operation involve? The healthcare team will carry out a number of checks to make sure you have the operation you came in for and on the correct side. You can help by confirming to your surgeon and the healthcare team your name and the operation you are having. Various anaesthetic techniques are possible, including a general anaesthetic or a local anaesthetic that is injected around your eye to numb it. Your anaesthetist or surgeon will discuss the options with you and recommend the best form of anaesthesia for you. The operation usually takes one to two hours. Your surgeon will remove the centre part of your diseased cornea and replace it with a part of a cornea from a donor (someone who has died). Your surgeon may replace the whole of your cornea (penetrating keratoplasty), the outer layers (deep lamellar keratoplasty) or just the inner layer (endothelial keratoplasty). Your surgeon will use small stitches to seal your eye. After the operation you should have a clear window for light to enter your eye so that you can see more clearly. The healing process is slow and it may take more than a year before you have the best vision in your eye. What should I do about my medicine? Let your doctor know about all the medicine you take and follow their advice. This includes all blood-thinning medicine as well as herbal and complementary remedies, dietary supplements, and medicine you can buy over the counter. What can I do to help make the operation a success? Keeping in the same position If the operation is performed under a local anaesthetic, you will need to lie still and flat during the operation. If you cannot lie still and flat, let your surgeon know. Your face will be covered with a cloth to allow your surgeon to work on a clean surface. Air will be blown gently towards your nose. If you are claustrophobic, let your surgeon know. Lifestyle changes If you smoke, stopping smoking several weeks or more before the operation may reduce your risk of developing complications and will improve your long-term health. Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight. Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice. What complications can happen? The healthcare team will try to make the operation as safe as possible but complications can happen. Some of these can be serious. You should ask your doctor if there is anything you do not understand. Your doctor may be able to tell you what the risk of a complication for you is. Copyright 2016 Page 2 of 4

4 1 Complications of anaesthesia Your anaesthetist or surgeon will be able to discuss with you the possible complications of having an anaesthetic. 2 General complications of any operation Pain is usually only mild and easily controlled with simple painkillers. You may feel pressure or mild discomfort. If you are in severe pain, let your surgeon know as this is unusual. Bleeding on the outside of your eye during or after the operation. Any bleeding is usually little and your eye may be slightly red. If it is very red and painful, let your surgeon know as this is unusual. Infection, which may cause blurred vision or even permanent loss of vision (risk: 1 in 150). Most infections usually happen in the first week but can happen later. If your eye becomes red and painful, and your vision becomes blurred, let your surgeon know straightaway. You may need other procedures to control the infection. 3 Specific complications of this operation Heavy bleeding inside your eye during surgery, which may cause permanent loss of vision (risk: 1 in 200). Inflammation in your other eye (sympathetic ophthalmia) (risk: 1 in 3 million). This is a potentially serious complication which may be treatable. If you develop pain or blurred vision in your other eye, let your surgeon know. Leak at your wound. Fluid in your eye may leak out by the stitches (risk: 1 in 12). You may need to have more stitches or wear a special soft contact lens (bandage lens) until the leak stops. Transferring infection from the donor, if the donor tissue is infected by diseases such as hepatitis or HIV. The healthcare team will test the tissue for infectious diseases to reduce the risk of this happening. Increase in eye pressure (risk: 1 in 8). This can usually be controlled with medicine but you may need another operation. Failure of the transplant, if your eye rejects the donor cornea (risk: 1 in 3 over a lifetime the risk is higher in the first 7 years). You may need to come into hospital for treatment. The transplant can also fail if the disease comes back (risk: 1 in 6). How soon will I recover? In hospital After the operation you will be transferred to the recovery area and then to the ward or day ward. You should be able to go home the same day or the day after. If you do go home the same day, a responsible adult should take you home in a car or taxi and stay with you for at least 24 hours. Be near a telephone in case of an emergency. The healthcare team will give you eye drops and sometimes medicine to take home. If you are worried about anything, in hospital or at home, contact the healthcare team. They should be able to reassure you or identify and treat any complications. Copyright 2016 Page 3 of 4

5 Returning to normal activities Do not drive, operate machinery or do any potentially dangerous activities (this includes cooking) for at least 24 hours and not until you have fully recovered feeling, movement and co-ordination. If you had a general anaesthetic or sedation, you should also not sign legal documents or drink alcohol for at least 24 hours. Your surgeon will tell you when you can return to normal activities. It is important to look after your transplant as you are told, to reduce the risk of complications. Do not swim or lift anything heavy until you have checked with your surgeon. Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice. Do not drive until your doctor tells you that you can. The future Most people make a good recovery. The cornea is usually not in the ideal shape to start with, so your eye may not be able to focus properly (astigmatism). Your surgeon can remove some stitches to improve the shape. It may take up to two years for your vision to improve. You will usually need glasses or to wear a contact lens. You may need to have an operation to change the shape of the cornea. Sometimes some of the stitches can break and cause irritation. You must have the broken stitches removed. The healthcare team will arrange for you to come back to the clinic regularly so they can check that the transplant is healing well and for signs of rejection. Rejection of the transplant can happen at any time after the operation and must be treated within hours. If you develop pain, blurred vision, or your eye becomes red, watery and sensitive to light, contact the hospital straightaway. Summary Disease of the cornea is a common problem that causes the transparent outer layer of the front of your eye to become less clear. If other treatments do not help, a corneal transplant can be performed to improve your vision. Surgery is usually safe and effective but complications can happen. You need to know about them to help you to make an informed decision about surgery. Knowing about them will also help to detect and treat any problems early. Keep this information leaflet. Use it to help you if you need to talk to the healthcare team. Acknowledgements Author: Prof Anthony King MD FRCOphth Illustrations: Medical Illustration Copyright Nucleus Medical Art. All rights reserved. This document is intended for information purposes only and should not replace advice that your relevant healthcare professional would give you. You can access references online at Use reference OP05. Copyright 2016 Page 4 of 4

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