Advice after your nerve block for surgery
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The Cornea
The cornea is the curved window at the front of the eye that must be clear to see. It is in front of the iris (the coloured part of the eye) and the pupil (the round black hole in the centre of the iris). A corneal graft is also known as a corneal transplant or a keratoplasty.
If your cornea is hazy, so that vision is reduced, a corneal graft may be beneficial. The corneal graft is taken from the healthy eye of an organ donor. In modern corneal graft surgery, only the unhealthy part of the cornea needs to be replaced.
Endothelial graft surgery replaces only the unhealthy inner layer (endothelium), instead of the whole of the central cornea. Preserving most of your own cornea means dramatically improved recovery times and vision compared with traditional full-thickness or penetrating corneal graft surgery.
The differences between DMEK and DSAEK
Endothelial graft surgery has gone through an evolution over the past decade. Grafts have become thinner and thinner, which tends to result in better vision.
- In DSAEK - which stands for descemet stripping automated endothelial keratoplasty.
- The graft is a disc of donor corneal tissue about 100 microns thick - a full thickness cornea is about 550 microns.
- In DMEK - which stands for descemet membrane endothelial keratoplasty.
- The graft is 10 microns thick.
DMEK can give slightly better visual results than DSAEK and has extremely low graft rejection rates so is our most common operation. Some eyes require DSAEK rather than DMEK.
What takes place during the operation?
Corneal endothelial graft surgery is performed under local anaesthetic (you are awake). The inner unhealthy membrane of your cornea is carefully removed and replaced by a very thin 8mm disc of donor cornea.
How long does the operation take?
Typically, about an hour. If combined with cataract surgery, an hour-and-a-half. At the end of the operation the front of the eye is left filled with an expansile gas to press the corneal graft into place.
After the operation we keep you lying flat on your back on the day ward for an hour or so. This is to allow the graft to attach properly.
Before you go home, your eye will be checked by the doctor. Occasionally some of the gas needs to be released from your eye while we check it at the microscope.
Once you arrive home it is important to stay lying on your back as much as possible, especially after the car journey home. Short breaks to eat, etc., are allowed. For the first night, try to sleep on your back as much as possible. The eye will be covered with a plastic shield to stop you rubbing it in your sleep.
Eye drops after the operation
Initially an antibiotic drop and a steroid drop usually will be given to use about 4 times a day.
Steroid eye drops are very important to prevent rejection of the graft and continue for at least a year. However, by the end of the year they are only put in once a day. It is very important not to run out of steroid drops.
Post-op appointments
Your first visit will be either a day or two after the operation or after a week. We then increase the period between visits, often 1 or 2 months. This will depend on each individual. You can expect to be seen about 3 or 4 times in the first year.
Is there anything I should avoid after the operation?
You can do most things, but you must not rub the eye in the first week, as this can dislodge the graft. You may swim, exercise and garden after 2 weeks. It is not safe to fly in the first two weeks because of the gas bubble in the eye.
Could I catch any disease from the transplant?
The medical history of the donor is checked to exclude the following conditions: rabies, Creutzfeldt-Jakob disease(CJD) and diseases of the nervous system of unknown cause. Blood is taken from all organ donors to exclude hepatitis B, hepatitis C and HIV. While the cornea is in the eye bank it is very carefully examined to reduce the risk of infection with bacteria and fungi; as a result of these checks the risk is tiny (much less than 1%). However, because of this tiny risk, once you have had a corneal transplant you will not be able to be a blood or organ donor.
Vision after surgery
The vision will be much more blurred for the first few days. After a month it should be as good as it was before, and then as the months go on there is normally further improvement up to about 2 years after the graft. If possible, you should not buy any new glasses for 4 months after the operation as the corneal shape changes.
Are there stitches?
The graft itself has no stitches. For DSAEK the entry incision at the edge of the cornea is stitched and is easily removed in the clinic if necessary. We decide after 3 or 4 months after a DSAEK and sometimes leave it there. After a DMEK the incision is smaller and a stitch is not usually required.
If the stitch is removed after a DSAEK your glasses prescription may change, so it is often best to wait for new glasses until this decision has been made.
How long the graft last
Most grafts will last for many years – often for life. Occasionally corneal grafts can fail and become cloudy. The most common cause is corneal graft rejection, and after this corneal endothelial failure - the cells of the cornea fail. The graft can be repeated if necessary.
Possible complications
- Graft Rejection
- Graft rejection is a possibility in any transplant surgery. This rejection results from your immune system recognising the graft as being "foreign". The vision becomes blurred and occasionally the eye becomes red, sore, and sensitive to light. This is very treatable but is best treated early. If you take your drops as instructed, graft rejection is very unlikely. This is less common after DMEK.
- Graft Detachment
- after DMEK occasionally the graft is not fully attached, and we might need to inject some air in the eye in clinic. Repeat surgery to attach a graft is rare.
- Infection
- Endophthalmitis is an infection inside the eye and can be severe. The signs are increasing redness, pain, discharge and reduced vision. Fortunately it is rare (about 1:1000 cases) and prompt treatment can help limit any damage. It is most common in the first 2 weeks after surgery.
If you develop severe pain in the eye on the first night which makes you feel very sick or vomit, please telephone Frimley Park and ask to speak to the emergency eye doctor. You will need gas releasing from the eye to stop a complication called pupil block, which can rarely be caused by the gas bubble. Do not go to the hospital’s main emergency department if possible.
| From 9am to 5pm Monday to Friday: | 0300 373 5884 |
| From 5pm to 9am and at weekends: | 0300 614 5000 and ask for the Eye Doctor on call |
Contact us
If you have any queries relating to this information, please contact the Ophthalmology service.
About this information
Service:
Ophthalmology
Reference:
QQ/026
Approval date:
1 May 2025
Review date:
1 May 2028
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.