Even Better!
I now have a link to photos of the actual surgery. on the left there is
a link to Hank's surgery. There are actual pictures and movies from the cornea
transplant he had done. The link a new page to the pictures so if you are
somewhat squeamish just close that browser window and you will be back here
NOTE FROM ME: What you read below is about exactly how it
worked. the operation took a very short period of time. I was first given an anesthetic
like valium (I can't remember the name) which made me pretty loopy. The I got a
shot near my eye which totally deadened that side of my face. I could not open
or move that eye which was a really good idea. later on in the operating room I
had something fitted over my face and head which only had an opening for my left
eye. they then opened my eye and began to work. later when I started becoming
more conscience I realized I could see the doctor cutting things and putting in stitches.
at first I thought I was imagining it so I asked him and he said that I was
seeing him work. that was both amazing and pretty damn scary.
again lifted with the greatest of ease using Cut and Paste technology courtesy
of MS from http://www.eyebank.org/corneal.html
CORNEAL TRANSPLANTS
(Penetrating Keratoplasty)
James D. Reynolds, M.D., Univ. of Arkansas School of Medicine
PROCEDURE
The surgery involves the partial or total replacement of the host cornea with
a donor cornea. Total replacement is much more common. The operation can be done
under general or local anesthesia and is increasingly being done as an
outpatient without an overnight stay in the hospital, but most still require one
to two days hospitalization. The operating time is approximately 60-90 minutes.
First, donor tissue is obtained and the recipient prepared in the operating
room. A round button of donor cornea is then cut to the desired size with an
instrument called a trephine. A matching round button of host cornea is also
cut, its precise depth being finely controlled. Next, the host button is
completely cut away with scissors, and the donor cornea button is sewed into the
defect created by removal of the diseased cornea. Tiny hair-thin sutures or
stitches are used to anchor the graft to the host tissue.
RECOVERY & RESULTS
The postoperative recovery is a long one, but most patients do well.
Strenuous activity such as lifting, bending or straining should be avoided for
several weeks. A protective shield is required and eye drops are prescribed for
several months. The sutures are removed between six months and two years.
The final improvement in vision is gradual and occurs six to twelve months
post-operatively. The results and success in restoring vision usually depend
more on the state of the original disease than the actual surgical manipulation.
Some corneal diseases, such as keratoconus, are more likely to have a favorable
outcome, while others, such as lye injuries, are not. In quantitative terms
success rates vary from 90-95 percent in uncomplicated cases to 5-10 percent in
severe lye burns.
COMPLICATIONS
As with all intraocular surgery, operative and postoperative problems can
occur. These include infection, bleeding, glaucoma, retinal detachment, poor
wound healing, cataract formation, inflammation and adverse reactions to
anesthesia. The overall complication rate is very low.
Two complications unique to transplant surgery are host rejection of the graft
and recurrence of the original corneal disease in the transplanted tissue. The
donor cornea is recognized by the host as foreign and causes the recipient's
immune system to mount a variably severe inflammatory response. Rarely, the
inflammation is great enough to destroy the clarity and health of the graft.
This must be controlled. The mainstay of anti-rejection therapy is suppression
of the immune response by cortisone-type steroid medication, usually in the form
of eye drops. Recurrence of disease in the donor graft is uncommon and limited
to certain types of diseases, like corneal dystrophy. However, this may be so
severe as to necessitate a second transplant.
INTRODUCTION
Many different disorders can affect the cornea, the clear outer covering over
the iris. When corneal clarity is significantly diminished or a disease process
becomes severe, corneal transplantation can bring new life to the diseased eye.
A corneal transplant is the replacement of a diseased cornea (host cornea) by
a donor cornea. Like kidney and liver transplants, the donor corneal tissue
comes from individuals who die and donate their organs for the benefit of
others. Organ donation is extremely important. It saves lives and restores sight
to others.
Unlike kidney and liver transplants, the corneal graft need not go through an
extensive typing procedure in order to match donor and host. The most important
factors for the selection of the donor are age, cause of death, length of time
between death and transplant, and the presence of donor eye disease, such as
herpes, AIDS or previous eye surgery.
INDICATIONS
The basic indication for a transplant is loss of vision due to
cornealopacification--in other words, the inability to see through a diseased
cornea. Among the causes of corneal opacification severe enough to limit
eyesight are injury, infection, inherent corneal disease such as keratoconus or corneal dystrophy, and corneal damage from previous eye surgery. Other
indications are relief of pain or discomfort, immediate repair of infectious or
degenerative perforations in the cornea, and possibly cosmetic reasons.
CONTRAINDICATIONS
There are probably no absolute contraindications to this surgery. Many eye
surgeons would not operate on a person who has an eye that is already blind,
although a chronically swollen and painful cornea in a blind eye could be
replaced for comfort and appearance. The patient would need to be willing to
take the risk while feeling that the alternatives were unacceptable.
Other contraindications are relative and depend on the general condition of both
eyes. A patient with glaucoma or ongoing eye inflammation should have these
conditions controlled before considering transplant. The presence of an anterior
chamber intraocular lens might necessitate removal of the lens before a corneal
graft could survive.
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