What is a cornea transplant?
The cornea is the clear dome at the front of your eye. It lets light in and does most of the focusing. When it becomes cloudy, scarred or badly misshapen, glasses and contact lenses can no longer give clear vision. A cornea transplant, also called keratoplasty or a corneal graft, removes the damaged tissue and replaces it with healthy tissue from a donor.
It is one of the most commonly performed transplant operations in the world. Because the cornea has no blood vessels, the immune system is less likely to attack it than other transplanted tissue, and blood group matching is not needed. Donor corneas come through eye banks, which test the tissue for disease and check it is suitable before it is released.
Who is it suitable for?
A transplant may be recommended if you have:
- Advanced keratoconus, where the cornea thins and bulges into a cone shape
- Fuchs' dystrophy or other inherited conditions that make the cornea swell and cloud
- Scarring or new blood vessels after an infection, such as herpes of the eye
- Scarring or clouding after an injury
- A cornea that has become swollen after earlier eye surgery
To benefit, the rest of your eye must be healthy. If the retina or optic nerve is damaged, a new cornea will not restore sight. The ophthalmologist checks this with an examination and an ultrasound scan of the eye.
Types of cornea transplant
Penetrating keratoplasty (full thickness)
The whole thickness of the central cornea is replaced. It is used when damage affects all the layers.
Anterior lamellar keratoplasty (front layers)
Only the front and middle layers are replaced, while your own healthy inner layer stays. It is often used for keratoconus and surface scarring, and it carries a lower risk of rejection.
Endothelial keratoplasty (inner layer)
Only the thin inner layer that keeps the cornea clear is replaced, through a small incision. Techniques include DSAEK and DMEK. Recovery is usually faster and fewer stitches are needed.
Keratoprosthesis
An artificial cornea may be considered when donor grafts have failed several times or are unlikely to succeed.
Partial transplants are preferred whenever they can solve the problem, because they carry lower risks and heal faster.
How the procedure is done
The operation usually takes 30 to 90 minutes, and only one eye is treated at a time.
Anaesthesia and preparation
Most transplants are done under local anaesthesia, with an injection or drops to numb the eye, although general anaesthesia is sometimes used. The eyelids are cleaned carefully and held open with a small clip.
Removing the damaged tissue
The surgeon measures the area to be replaced and removes the damaged layer or disc of cornea with a fine circular cutting instrument. If you also have a cataract, it can be removed and an artificial lens placed at this stage.
Placing the donor tissue
The donor tissue is positioned and secured with very fine stitches, or, in an endothelial transplant, held in place by an air or gas bubble.
Protecting the eye
Antibiotic ointment is applied and the eye is covered with a pad and shield.
Recovery timeline
- Day 1
The pad is removed at your first check. Your vision will be blurred and the eye may feel scratchy. After an endothelial transplant you may be asked to lie on your back for some hours to keep the bubble in place.
- Week 1
You start steroid and antibiotic drops and have a further check before flying home. Most people can manage light activities within one to two weeks.
- Months 1–3
Vision gradually improves, faster with partial transplants. Drops continue on a reducing schedule.
- Months 3–18
Stitches are removed in stages over several months, which can change the focus of the eye. After a full-thickness transplant, vision often keeps improving for a year or more.
Aftercare
- Use your drops exactly as prescribed, often for many months
- Do not rub or press on the eye, and wear the shield at night for the first weeks
- Wash your hair with your head tilted back, as at the hairdresser, to keep water and soap out of the eye
- Wear sunglasses outdoors to protect against light and dust
- Avoid swimming, heavy lifting, cycling and contact sports until your surgeon agrees
Risks and side effects
Your surgeon will discuss the risks before you consent. They include:
- Graft rejection, which is usually treatable if caught early
- Infection
- Bleeding
- Raised pressure in the eye (glaucoma)
- Astigmatism or an irregular corneal shape that slows visual recovery
- Problems with stitches, or a graft that does not stay clear
- Retinal detachment, which is rare
Rejection can happen years later, so it is important to know the warning signs and to keep up with eye checks for life.
Results
The large majority of grafts stay clear, and many last for decades. Most patients notice a real improvement in vision, though many still need glasses or contact lenses to see their sharpest. If a graft fails, the operation can be repeated.
Cornea transplant in Turkey: your trip
Before you fly
Send a recent eye report and your medical history. You will be asked to have your eye measured so a suitable donor cornea can be arranged, and to check any medicines you take with the team. Plan to arrive the day before surgery.
In Istanbul
A VIP driver takes you from the airport to your hotel, and a translator stays with you through tests, surgery and check-ups. A companion can come at no extra cost, and meals, tests and medication are included.
Back home
Your coordinator is available 24/7 on WhatsApp. You will need regular checks with a local eye specialist, and your coordinator can pass their findings to your surgeon.
What the Cornea Transplantation package includes
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Hospital and medical care
Your private hospital room, nursing care, pre-operative tests, consultations with your surgeon, anaesthesia, the operation itself and the medication you take home.
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VIP transfers
A private driver meets you at the airport and takes you between the airport, your hotel and the hospital.
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Translator and companion
A medical translator at the hospital, and a companion can travel with you at no extra cost.
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Meals and comfort
Daily meals for you and your companion throughout your stay.
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24/7 patient coordinator
A dedicated coordinator answers your questions before, during and after your trip, in your language.
Cornea Transplantation FAQ
Where does the donor cornea come from?
Corneas come from people who agreed to donate after death. Turkey's eye banks screen the tissue for disease, check its quality and send it to the operating centre. You will be asked for eye measurements in advance so that a suitable cornea can be prepared.
Do I need a matching blood group?
No. The cornea has no blood vessels, so blood group matching is not needed, and the risk of rejection is lower than with most other transplants.
What are the signs of rejection?
Watch for redness, increasing sensitivity to light, blurred or worsening vision and pain in the treated eye. Contact your coordinator straight away if you notice any of these, because rejection caught early can often be reversed with stronger steroid drops.
How long until my vision improves?
With a partial transplant of the inner layer, vision often improves within weeks. After a full-thickness transplant it can take a year or longer, because the stitches and the shape of the new cornea settle slowly. You may need glasses or contact lenses for the best result.
Can both eyes be done at once?
No. Each eye is treated separately so the first can heal and be checked before the second is considered.
Can I fly home after a cornea transplant?
Most patients fly home after about a week, once the surgeon has checked the eye. If a gas bubble was placed inside your eye, you must not fly until it has been absorbed, and your surgeon will tell you when it is safe.
Can a transplant be repeated if it fails?
Yes. If a graft becomes cloudy or is rejected and does not respond to treatment, a repeat transplant is possible, although the chance of rejection is somewhat higher the second time.
