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A personal account of what it's like.

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Cornea% Corneal &raft% DALK % Deep Anterior Lamellar Keratoplast% Keratoconus% (enetratin"Keratoplast% (K 

Deciding to Have a Cornea Transplant and

What it Involves

Au"ust )*% )+**

So in the last post , talke$ aout ein" $ia"nose$ with Keratoconus when , was *-% an$

mentione$ that the con$ition in m ri"ht ee has pro"resse$ to the sta"e where contact lenses nolon"er work a cornea transplant is now the onl /iale option. ,n this post ,0ll talk aout wh ,

$eci$e$ to ha/e a cornea transplant now an$ "o into more $etail aout what a transplantin/ol/es.

Deciding to have a corneal graft

Despite ein" $ia"nose$ with KC when , was 1uite oun" 2most cases of KC ten$ to e

$ia"nose$ in a person0s teena"e ears3% it0s ne/er reall affecte$ m life to an "reat e4tent. ,

soon foun$ that har$ contact lenses were almost impossile for me to wear $ue to them ein" souncomfortale% so ,0/e alwas 5ust cope$ without them. , alwas foun$ that , coul$ rea$% watch

T6% rea$ si"ns in the street etc completel fine% an$ e/en thou"h m /ision was o/iousl not as

"oo$ as a person with )+:)+ /ision% it wasn0t so a$ that , coul$n0t function normall in $a to$a life. Luckil m left ee has alwas ha$ "oo$ /ision% an$ e/en thou"h the /ision in m ri"ht

ee has alwas een prett terrile% m rain is so use$ to the /ision of oth ees that it ten$s to

7lock out0 the poor /ision of m

ri"ht ee% an$ focuses more on the "oo$ /ision of m left.

The prolems starte$ to occur in 8a )+*+. ,0m not sure wh% ut su$$enl , foun$ that , was

stru""lin" just slightly more than , use$ to when rea$in" a computer screen or watchin" T6. ,t

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wasn0t a ma5or chan"e% ut the 1ualit of m /ision seeme$ to ha/e $ecrease$ 5ust enou"h to

make me feel like , now nee$e$ to wear contact lenses to see etter. ,n the past ,0$ alwas

achie/e$ "oo$ /ision in oth ees with contact lenses% an$ assume$ it woul$ e the same thistime.

,t was clear almost strai"ht awa that this time it was "oin" to e a lot more complicate$. Atsome point in the last ear or so the KC in m ri"ht ee ha$ pro"resse$ e/en more than it alrea$

was. The cone was now so steep that it was almost impossile to achie/e "oo$ /ision in m ri"htee with lenses. Durin" the course of se/en months from 8a Decemer )+*+% , ha$ countless

lens fittin"s trin" $ifferent si#es 2inclu$in" scleral lenses% which are the si#e of a ) pence

 piece93 an$ shapes until it was o/ious that nothin" was reall "oin" to work. ,t was then that mconsultant e"an to $iscuss the possiilit of a cornea transplant.

8 initial reaction to a transplant was that , $i$n0t want to ha/e one at all. ,0$ spent the last ten

ears li/in" like , almost $i$n0t ha/e KC% an$ up until the pre/ious si4 months ,0$ often for"ot

that , e/en ha$ KC. Durin" those si4 months of faile$ lens fittin"s howe/er% ,0$ starte$ to realise

that , ha$ some i" $ecisions to make. , coul$ either 5ust li/e with the eesi"ht that , ha$ an$hope that it $i$n0t "et an worse% or , coul$ wei"h up the /arious enefits an$ risks of a

transplant an$ "o for it.

,n the en$ m $ecision to ha/e a transplant was 1uite strai"htforwar$ , realise$ that ,0$ asicall een li/in" in a it of $enial with re"ar$s to m KC. ,0$ cope$ perfectl fine since ein"

$ia"nose$% ut , su$$enl realise$ that , $i$n0t want to 5ust 7cope0 an more , wante$ to tr an$

"et ama#in" /ision instea$ of the half lurr worl$ ,0$ een li/in" in for the last few ears. , alsorealise$ that , was completel relin" on the fact that the /ision in m "oo$ left ee woul$n0t

chan"e ,0m so reliant on the /ision of m left ee that if% for some reason% the KC starte$ to

 pro"ress in that ee an$ m /ision $eteriorate$% , woul$ e completel screwe$. , $i$n0t want to

li/e the ne4t ten ears of m life worrin" if m /ision woul$ "et worse% or 5ust 7makin" $o0 withthe /ision that , ha/e. , felt that now was the time to 5ust take the risk an$ "o for the transplant.

,t0s important to note a"ain that onl *+ of KC patients will reach the sta"e where the nee$ a

transplant. There are some fantastic proce$ures a/ailale now which weren0t as wi$esprea$ tenears a"o% such as corneal cross linkin"% which actuall helps to stop the pro"ression of KC so

that it $oesn0t reach the sta"e where a "raft is nee$e$. Howe/er% if like me ou0re at the sta"e

where ou0re startin" to think of ha/in" a "raft% m a$/ice woul$ e to 5ust $o as much researchas ou can% an$ take as lon" as ou nee$ to $eci$e. ;ou0ll proal fin$ that at some point ou

 5ust know what ou want to $o whether that0s to "o for a transplant or keep thin"s as the are.

The $ecision is ours to make onl when ou feel rea$.

Two types of Cornea Transplant: PK vs DALK 

There are two main tpes of cornea transplant: A Penetrating Keratoplasty 2also known as (K

or a full thicness graft3% or a Deep Anterior La!ellar Keratoplasty 2also known as a DALK

or a partial thicness graft3. ,0ll e ha/in" a DALK transplant an$ ,0ll now "o throu"h the$ifferences etween the two.

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Penetrating Keratoplasty

This is the most common form of cornea transplant% an$ in/ol/es remo/in" the full thickness of

a person0s cornea% an$ replacin" it with the full thickness of a piece of $onor cornea. <hat $oes7full thickness0 mean= <ell% the cornea is asicall ma$e up of a numer of fine 7laers0% an$

each laer is responsile for performin" a $ifferent function. <hen a 7full thickness0 transplant is performe$% all of the laers are remo/e$ in one "o% an$ replace$ with a full $onor cornea.

Pros:

• >ecause all of the laers are remo/e$ in one "o% the proce$ure is 1uite simple.

• A full thickness "raft usuall pro/i$es e4cellent /isual outcomes

Cons

• "e#ection is the i""est risk associate$ with an transplant% an$ with a full thickness

"raft it is one of the ma5or risks. Re5ection occurs when the o$ $etects that a piece of

tissue from another person has een put into ou% an$ then tries to attack it with itsimmune sstem. Aout one in se/en people who ha/e a corneal "raft will ha/e a re5ection

attack at some sta"e. The ee ecomes re$% water an$ "ritt an$ if left untreate$% the

cornea fails an$ nee$s to e remo/e$. ,f cau"ht 1uickl howe/er% stron" steroi$ $rops canusuall re/erse it.

• ,nfection. Since the cornea has no loo$ /essels it heals much more slowl than a cut on

the skin. <hile the woun$ is healin"% it is possile that it mi"ht ecome infecte$

 acteria. Antiiotic ee $rops nee$ to e use$ $ail to pre/ent this happenin".

Deep Anterior La!ellar Keratoplasty

This is a relati/el newer form of transplant compare$ to (K% an$ is particularl suitale for

Keratoconus patients who% $espite the chan"e in shape of the upper laers% still ha/e a cornea

who0s lower laers are health an$ functionin". The i$ea with this techni1ue is that the last two

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laers of the patients cornea 2the Descemet memrane an$ ?n$othelium3 are actuall left an$ the

$onor cornea is place$ on top of these laers hence the reason it "ets refferre$ to as a 7partial

thickness0 "raft.

Pros:

• >ecause the patients en$othelial laer is left on% the risk of re5ection is re$uce$ massi/el

 ecause the o$ $oesn0t realise that a new cornea has een place$ on top. This in turn

means that less steroi$ $rops are nee$e$ than with a (K. 2prolon"e$ use of steroi$ $ropscan lea$ to cataracts formin" an$ li/er prolems3

• >ecause the whole cornea isn0t remo/e$% the ee retains some structural stren"th% an$

ma e less /ulnerale to in5ur than an ee that has ha$ a (K.

• Healin" time ten$s to e 1uicker stitches can sometimes e remo/e$ si4 months after the

operation instea$ of the usual *)*@ months for a (K.

Cons:

• The operation itself takes lon"er an$ is technicall more $eman$in" than a (K ecause

the sur"eon nee$s to split the cornea into laers an$ remo/e them in$i/i$uall.

Sometimes it ecomes impossile to complete the operation as a DALK an$ the sur"eon

nee$s to con/ert it to a (K.

• >ecause the $onor cornea is place$ onto laers of the patients cornea% the /ision achie/e$

after a DALK can e less crisp an$ clear than with a (K.

Despite the cons associate$ with a DALK% it was actuall the fact that , was suitale for this kin$

of proce$ure that swae$ m $ecision to ha/e a transplant. ne of m main fears aout ha/in" a

transplant was that the new cornea coul$ re5ect an$ fail. <hen a "raft fails the patient eithernee$s to use stron" steroi$ $rops for a lon" perio$ of time 2which as note$ ao/e can lea$ to its

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own complications3% or a new cornea transplant must e performe$. The prolem with this is that

each time a new transplant is performe$% the chances of success ecome less an$ less% so that

the fifth or si4th transplant% the chance of success is -+ or less 2the chance of success for a KC patient on their first cornea transplant is sai$ to e B+B-3.

>ecause a DALK almost eliminates the chance of re5ection an$ lessens the reco/er time% itseems to e a far more eneficial proce$ure than (K% an$ ,0m willin" to put up with a sli"htl

less clear /isual outcome if it means that the healin" process is less complicate$.

So that rin"s us prett much up to $ate. ,0ll e ha/in" m operation on Au"ust ))n$ )+** an$

,0ll tr an$ "i/e a full account of what happens as well as re"ular up$ates on how the healin"

 process "oes for as lon" as , can. Fin"ers crosse$9

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o Thir$ (ostAssessment Appointment

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o ,ntro$uction: 8e an$ m <eir$ Cornea

 

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