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Corneal Transplantation Surgery in Israel

What is the cornea?

The cornea is the transparent portion of the eye which allows light to enter and performs two-thirds of the focusing tasks.
Sometimes, the cornea becomes damaged through disease, infection, or injury, resulting scars or discoloration. In such cases, the cornea loses its transparency. Also, it can interfere with vision by blocking or distorting light as it enters the eye causing blurred vision. In some cases, where there is no possibility to improve vision by optical correction using glasses, contact lenses, or medication, there is a need for the cornel transplantation.

What is the corneal transplantation operation?

The corneal transplantation is a surgical procedure where a damaged cornea is replaced with healthy donated tissue taken from a recently deceased individual.

DSAEK video of corneal surgery that is being performed by Prof. Igor Kaiserman MD MSc

All patients must undergo the detailed clinical examination that is being done by Prof. Igor Kaiserman before the surgery. Next, there are set the treatment schedule and the final surgery cost. Typically, a price for the corneal transplantation ranges from $13,500 to $17,500 per one eye.

When is a corneal transplant necessary?

A corneal transplantation is done when damage to the cornea causes a drop in vision, or pain that interferes with daily activities. In addition, there is no possibility to improve vision by optical correction using glasses, contact lenses, or medication.

What are the most common corneal dystrophies that require transplantation?

  1. Corneal damage after cataract surgery in the eyes (clouding of the cornea).
  2. Keratoconus, eye disease in which the normally round cornea thins and begins to bulge into a cone-like shape.
  3. Hereditary (genetic) corneal dystrophy and other inherited corneal diseases.
  4. Scarring after infections, especially after herpes.
  5. Corneal graft rejection.
  6. Scarring after corneal injury.
  7. Burns.

Where does donated cornea come from?

For the most part, a human-donated cornea comes from people who are dead, as well there is available the consent of donor or donor’s family.
All donated corneas for the transplantation are closely inspected for the quality and absence of infectious diseases, such as HIV (AIDS), hepatitis, and so on.

How is corneal transplant surgery done?

The corneal transplant surgery will be done under a surgical microscope. The damaged part of the cornea will be cut out. The new cornea will then be placed in the opening. The new cornea will be fastened with very fine stitches. Finally, a patch and shield will be put over the eye. Patients typically do not feel these stitches after a few days, and they usually stay in place for one year, after which they are removed in the ophthalmologist's clinic. Besides, the corneal transplant surgery will not change the color of your eyes, since it is determined by the iris.
Also, there are some surgeries in which only central section of cornea is replaced, depending on the nature of the problem. It is possible to replace only the front layer (epithelium) of the cornea when it comes to keratoconus or corneal scarring. In this case, the risk of corneal graft rejection drops down in the future.
There is also an option to replace only the back layers of the cornea (the corneal endothelium or posterior corneal epithelium) in the case if it is damaged by diseases, such as Fuchs’ dystrophy or keratopathy.

What type of anesthesia is used for corneal transplant surgery?

Two types of anesthesia can be used during a corneal transplant:

  • Local anesthesia to numb the eye — Before the surgery a patient will be given a local injection of anesthetic near the eye.
  • General anesthesia — puts the entire body to sleep by giving medicine.

How long will the surgery take?

  • Local anesthesia— about one and half hours
  • General anesthesia — about two hours

Post-surgery care

Immediately after surgery a patch and shield will be put over the eye.

  • Mobility: A patient is free to move around and get out of bed.
  • Prevention of corneal graft rejection: A patient should use eye drops and medication as prescribed to prevent the possibility of infection and graft rejection.
  • Medication therapy: A patient should continue to take medication as prescribed by a doctor.
  • Food: A patient should eat and drink as usual.
  • Pain control: A patient should take painkillers in case of the pain.
  • Nausea and vomiting: These symptoms are possible after the surgery that was done under the general anesthesia. A patient should notify the nurse and get the proper medicine.
  • Bath and shower: A patient may take a shower, but should not wet the eye during the first post-surgery days.

What is the duration of hospital stay?

A patient will most likely go home after a few hours in the recovery area. There may be situations that require some additional hospital stay.

What are possible complications after surgery?

The procedure is highly successful. Severe complications are rare, however, there are possible some complications, such as:

  1. High ocular pressure
  2. Infection
  3. Corneal graft rejection of the new cornea—The body’s defense system attacks the new tissue, damaging it. Such situation may occur during the first year after transplantation. Risk of rejection decreases with the passage of time, however, it may occur at any time after surgery, even after a number of years. The operation is most successful for patients who have keratoconus and corneal scars.
  4. Deformation and unevenness of the transplanted cornea. Most of the above complications are treatable. In most cases, the vision gets better.

Here are the following vision symptoms of graft rejection: corneal opacity and blurred vision, light sensitivity, corneal redness, irritation and pain in the eyes.
If any of the following symptoms occur, please immediately contact the eye doctor.

Patient discharge instructions

After a patient leaves the hospital, there will be given a written doctor's opinion, including a prescription for eye drops.

Post-surgery supervision

It is recommended to make an appointment with Prof. Igor Kaiserman to have regular checkups after the surgery. Later on, during the first post-surgery year regular checkups will be required every few months, and then once in six months.
Pain therapy: A patient should take painkillers in case of the pain in accordance with the doctor’s recommendations.
Eye discharge: In the first post-surgery days, slight eye discharge may occur. A patient should use a clean cotton wool soaked with cool boiled water and wipe the eye from the inside corner out, each time using a new ball of cotton wool.
Medication therapy:

  • Eye drops are typically prescribed after the surgery for a period of six months to a year. Eye drops should be used according to the instructions of Prof. Igor Kaiserman. It is very important to use the eye drops in a timely manner in order to keep the transparency of the cornea and prevent the risk of rejection.
  • It is prohibited to terminate or make any changes in the treatment procedure without consulting with Prof. Igor Kaiserman.

Prevention of infections: The new cornea that was transplanted is exposed to infection more than the old one. A patient should avoid staying in a contaminated environment (for example, swimming in the sea) and following strict personal hygiene measures.
Eye protection:

  • A patient should wear glasses during the day within the first 3 post-surgery weeks as protection measure. Also, the patient should be wearing a shield to protect the eye at night, which will be given after the surgery. In addition to that a patient must avoid the hard work activities.
  • A patient should not swim or do any contact sports until allowed by a doctor.
  • A patient should avoid direct contact with eyes (for example, hugging a child or playing with pets).

Removing surgical stitches: The surgical stitches are removed after a few months to a year after the surgery. The doctor makes a particular decision for each case individually.

Eye drops instructions

Basic rule: Due to a risk of infection, a patient should not use expired eye drops.

  1. Wash hands with soap and water (preferably liquid soap) before applying eye drops and after it.
  2. Look upward towards the ceiling (it weakens blinking).
  3. Use free hand to pull down the lower eyelid.
  4. Apply some eye drops inside part of the eye.
  5. Close the eye and wipe it from the inside corner out. Then discard the used cotton wool, as it is not recommended to reuse it many times. Also, If there prescribed several types of eye drops, as it is recommended to keep a five-minute interval between applying the eye drops.
  6. Make sure to keep the eye drops in accordance with the manufacturer's instructions that added to the medicine.

How do I know if the cornea transplantation is successful?

The cornea requires for its healing after the transplantation a particularly long period. For this reason, vision may often change. Therefore, vision can be corrected with glasses or contact lenses, but these measures could be only used for a few post-surgery months upon availability of an acceptable level of recovery. In most cases, the patient will see well enough using the glasses and the contact lenses will be used only in certain situations. Anyway, good vision will come in a year after the surgery, although in some cases, good vision may come back soon after the surgery.

When should I seek medical attention?

It is very important to be aware of the infection danger and/or symptoms of a possible corneal graft rejection. If they are noticed, a patient should go to the Medical Center and notify Prof. Igor Kaiserman right away. As quick diagnosis and quality rejection treatment will reduce the risk of corneal graft loss. Therefore, in case of an emergency a patient must contact the Medical Center for medical help right away.
Here are stated the following vision symptoms:

  • Blurred vision
  • Increased eye redness
  • Increased pain
  • Significant eye discharge