What Is Keratoplasty?
Keratoplasty is the medical term for a transplant of the cornea. There are three types of Keratoplasty:
The surgery gets its name form a certain type of cell in the centre of the cornea called a keratocyte. These cells are responsible for the production of collagen in the cornea. The cornea is the transparent film in front of the eye that allows light in. It also bends light to allow people to focus on different objects.
If the cornea becomes damaged or diseased, it can lose transparency, or thin and become conical instead of spherical. The replacement cornea can either come from a donor or be synthetic. In the UK Keratoplasty may often be available on the NHS however if you want to beat the queues for this correction procedure there are also many private clinics offering it.
The tissue required to carry out keratoplasty is harvested from the donor within 24 hours of death.
Certain tissue, such as that harvested from a very young donor or a donor over the age of 70, may not be suitable. During penetrating keratoplasty, the graft size is determined pre-operatively, the diseased host tissue is removed, and the new donor tissue is inserted and fixed in place with non-absorbable sutures. The stage with the highest proclivity for complications is when the diseased tissue is removed. During lamellar keratoplasty, the process is similar, except only partial thickness of the cornea is grafted. During deep lamellar keratoplasty, a newer procedure, a greater proportion of the anterior corneal layers is removed, and there is a more complicated and thorough process of corneal layer dissection, removal and graft placement.
During deep lamellar endothelial keratoplasty (DLEK), only the endothelium is replaced, whereas in a so-called 'triple procedure', a penetrating keratoplasty takes place alongside cataract extraction and an intraocular lens implant.
What To Expect
Keratoplasty may be carried out under a general or local anaesthetic as required, and can either be conducted as an outpatient procedure or may require an overnight stay. The procedure can take between one to two hours to complete, and following the operation, a protective pad will be placed over the eye. It is normal for patients to experience some slight swelling and discomfort following the procedure, but this will dissipate in time.
You may be prescribed some topical steroid and/or antibiotic drops, along with other treatments specific to the cause of your keratitis. You will need to attend a number of follow-up procedures, not only to remove the sutures, but also to check on the progress of your healing and monitor things like infection.
It is important to contact your clinic immediately if you experience any of the following complications:
- Chronic epithelial defects lasting longer than two weeks
- Protruding sutures
- “Foreign body sensation” and red eye
- Iris prolapse
- Elevated intraocular pressures
- Endophthalmitis, a rare but sight-threatening condition that should be treated as an emergency
Later complications could include a recurrence of the original disease process, Glaucoma, Astigmatism, and suture-related issues.
With any tissue transfer procedure, there is the possibility that the graft will be rejected. If this is to be the case, it will likely occur on the same day as the operation, although 50% of graft rejections occur within six months of the procedure. If you are experiencing red eye, reduced visual acuity, cloudiness in the eye and uveitis, contact your surgeon immediately.
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Penetrating Keratoplasty Treatment
A penetrating keratoplasty is one where a circular section in the centre of the cornea is removed and replaced by donor tissue. The cornea is then fixed into place, which may be visible after the operation and are removed after one to two years. The operation can be performed under local or general anaesthetic and takes between one and two hours.
Costs for this procedure vary between clinics and the individual patients needs. A quote can only be given once the ophthalmic surgeon has examined the patient but will be over £1,500 per eye. Often this procedure will be covered by medical insurance.
Conductive KeratoplastyConductive Keratoplasty, abbreviated to CK, is one of the latest methods of eye surgery to improve vision. Unlike other treatments available, it is non-invasive and does not use lasers. It can be used to treat hyperopia (farsightedness) and presbyopia (aging eyes), as well as other similar conditions, and can be performed in a matter of minutes.
Typically, it is only available to patients over the age of forty who require reading glasses but otherwise have stable vision. This is therefore an alternative for relevant patients looking to have laser eye surgery in the UK. As most people’s eyes deteriorate with age, CK may be needed more than once over the years to maintain optimum vision.
Conductive Keratoplasty is a refractive surgery which alters the cornea by shrinking the collagen in specific areas using radio waves. The eye surgeon will use a hand held device, similar to a pen or wand, with a tiny probe that emits low-level radio frequency energy to specific spots on the cornea. These spots form a circle around the cornea, and when treated with radio energy they gradually contract, having the effect of a tightening belt around the cornea. This gradual tightening causes the curve of the cornea to become steeper, which in turn causes vision to become clearer due to the way light enters the eye and is interpreted.
Conductive Keratoplasty is commonly only performed on one eye, to give what is known as monovision. Therefore, one eye is near sighted and one longsighted. For this reason, the cost of CK is assessed per eye, starting at around £1000 for one eye.
In a lamellar keratoplasty, a section of the cornea is removed. The surgeon creates a small flap in the eye and then removes a small disc from the cornea and the flap is then reattached. This is an invasive procedure similar to the penetrating keratoplasty.
The costs in the UK for this procedure will be similar to those involved in penetrating keratoplasty if it is performed privately. Again the exact price will be given at your initial consultation.